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Suraj Singh Senjam,1 Yatan Pal Singh Balhara,2 Pameshwar Kumar,3 Neeraj Nischal,4 Souvik Manna,1 Karan Madan,5 Nishat Hussain Ahmed,1 Noopur Gupta,1 Praveen Vashist,1 Randeep Guleria5 1Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 2Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India; 3Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India; 4Department of Medicine, All India Institute of Medical Sciences, New Delhi, India; 5Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Suraj Singh Senjam, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Tel +91-011-2659-3032 ; +91 9968856431, Email drsurajaiims@gmail.comPurpose: With millions of people being affected by COVID-19, people living with post COVID-19 clinical symptoms (PCS) are expected to rise further. The primary aim of the study was to comprehensively assess self-reported PCS and its associated risk factors among beneficiaries of Hospital Employee Scheme of a tertiary healthcare institution in Delhi.Patients and Methods: An online cross-sectional study was conducted using a semi-structured questionnaire developed by employing nominal group technique among individuals aged 18 years and above who were novel SARS-CoV-2 positive from January to April 2021. Participants were telephoned first, before sending the online survey link. Socio-demographic data, information on PCS along with potential risk factors, pre-existing morbidities, vaccination status, severity of acute illness and management were collected between June and July 2021. PCS was presented as relative frequency; Chi-Square test and odds ratio; adjusted values were used to rule out any association between PCS and predictors.Results: In total, 773 of 1801 eligible participants responded to the survey (completion rate 42.9%), with a median age of 34 years (IQR 27– 44). Males accounted for 56.4% and PCS was present in 33.2%. The most prevalent symptoms were fatigue (79.3%), arthralgia (33.4%), myalgia (29.9%), hair loss (28.0%), headache (27.2%), breathlessness (25.3%), and sleep disturbance (25.3%). The prevalence of PCS was reduced to 12.8% at 12 weeks. Female gender, older age, oxygen supplementation, severity of acute illness, and pre-existing co-morbidities were positively associated with PCS. Vaccination (second dose) reduced the odds of developing PCS by 39% compared to unvaccinated participants (aOR 0.61; 95% CI 0.40– 0.96).Conclusion: PCS affects almost all organ systems of the body, regardless of the severity of acute COVID-19 illness. Two doses of vaccine hel reduce the development of PCS.Keywords: COVID-19, post COVID-19 symptoms, long COVID-19, cross-sectional study, Northern India

Byline: R. Sagar, S. Varghese, YPS. Balhara Sir, Olanzapine, a newer antipsychotic, is among the commonly prescribed antipsychotics around the world. The side effect profile of these newer antipsychotics is [...]

Objectives: This study aims to examine the sources of stress among first-year medical students; the frequency of their coping strategies; the factors associated with specific stressors and specific coping strategies adopted by the participants., Methods: We conducted a cross-sectional study with 409 first-year students at the University of Medicine and Pharmacy, Vietnam. The Vietnamese versions of the Higher Education Stress Inventory (V_HESI) and Brief Coping Orientation to Problems Experienced (V_Brief COPE) were validated and were used as measurement instruments for participants' sources of stress and coping strategies frequencies. The survey comprised questions of socioeconomic status, stress-related issues, the six sources of stress (using the V_HESI), and the nine coping strategies (using the V_Brief COPE)., Results: Among the six sources of stress, "Worries about future competence/endurance" had the highest mean score (3.02±0.64), while "Mismatch in professional role expectations" had the lowest score (1.60±0.53). "Financial concerns" and "Academic workloads" were also significant sources of stress. Regarding coping strategies, Self-distraction was most frequently adopted by the participants (2.80 ± 0.68). Problem-solving (2.72±0.53) and seeking Social support (2.62±0.70) were also common adaptive strategies. Avoidance (1.87±0.55) and substance-use (1.27±0.55) were the least frequent strategies. Students who experienced acute stress event were more likely to have financial concerns compared to others. Substance use was positively associated with stressors from "Mismatch in professional role expectations", "Non-supportive educational environment", "Having physical issues" and "Having part-time job". Self-blame was more frequent among students with "Worries about future competence/endurance", "Financial concerns", and "Academic workload". Male student tended to adopt humor strategy (β = 0.19, p = 0.02), while less likely to utilize religious practices (β = -0.21, p = 0.01)., Conclusions: Two-thirds of the participants reported moderate to high levels of stress. "Worries about future competence/endurance" was the most concerned stressor, followed by "Academic workload", and "Financial concerns". The first-year medical students reported high frequency of utilization "Self-distraction", "Problem-solving" and "Social support" when confronting stress. The findings may help inform the school management to better support students' well-being., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nguyen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Nomophobia or no-mobile-phone phobia, defined as the fear of being unable to use or being unreachable via one's mobile phone. The pervasive concern has varied bio-psychosocial and clinical implications in an individual's life. Nomophobia is currently in an exploratory phase., Methods: A scoping review was conducted to systematically map the relevant evidence and literature on nomophobia. The review of scholarly literature spanning from January 2010 to May 2023 employed a narrative synthesis methodology to succinctly encapsulate the research findings. Additionally, it encompassed a meticulous examination and visual representation of studies, detailing both the frequency of investigation into specific variables and the instances in which said variables exhibited a statistically significant association with nomophobia., Results: A thorough examination of 92 studies revealed a total of 133 variables spanning demographic, lifestyle-related, academic, smartphone-related, psychosocial, and clinical domains. Notably, 42.86% of these variables have only been investigated in a single research study, underscoring the imperative for replication to enhance the generalizability, validity, and applicability of research findings. Moreover, the review identifies Nomophobia Questionnaire (NMP-Q) by Yildirim and Correia as the most widely used tool for measuring the severity of nomophobia., Conclusion: There is a crucial need for homogeneity and consistency in reporting nomophobia scores and establishing corresponding gradations indicative of functional ramifications or clinical severity of nomophobia. The findings elucidate significant research gaps in existing literature on nomophobia, hold implications for further synthesis of data, and contribute to a comprehensive understanding of nomophobia; ensuring superior diagnostic accuracy and precision, and facilitating successful delivery of targeted interventions., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Psychiatry.)

Background: Nomophobia is a situational phobia evoked by unavailability of smart phone or the thought of the possibility of not having it, not being able to use it and losing it. Currently used instruments for assessment of severity of nomophobia offers challenges of administration and have limited applicability in the Indian setting. Therefore, this study was aimed to depict and understand the lived experience of college students with nomophobia and making sense of it., Methods: This interpretative phenomenological analysis research design study was carried out on 17 undergraduate students belonging to different academic streams including Science, Social science and Commerce from the three study sites situated in different locations of India. An in-depth interview guide was prepared. The students who scored more than 90 on nomophobia questionnaire (NMP-Q Questionnaire) were included in the study. The data was recorded in audio and video format, it was transcribed, and translated from Hindi to English language. Coding was done and the theme were extracted., Results: The findings identified six superordinate themes: Digital Obsession, Digital Compulsion, Approval Motivation, Digital Intensement, Digital Well-being and Insight., Conclusion: The lived experiences of the students with nomophobia had explicitly shown a strong inclination towards the smartphone. They also focused on some of the significant aids provided by the smartphone. Further the intensive use of the smartphone was posing major challenges to the students when they were away from it., Competing Interests: The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© 2024 The Author(s).)

Competing Interests: There are no conflicts of interest.

Background: Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage., Methods: A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR., Findings: A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3-7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2-2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties., Interpretation: Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Senjam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Aberrance in switching from default mode network (DMN) to fronto-parietal network (FPN) is proposed to underlie working memory deficits in subjects with substance use disorders, which can be studied using neuro-imaging techniques during cognitive tasks. The current study used EEG to investigate pre-stimulus microstates during the performance of Sternberg's working memory task in subjects with substance use disorders., Methods: 128-channel EEG was acquired and processed in ten age and gender-matched subjects, each with alcohol use disorder, opioid use disorder, and controls while they performed Sternberg's task. Behavioral parameters, pre-stimulus EEG microstate, and underlying sources were analyzed and compared between subjects with substance use disorders and controls., Results: Both alcohol and opioid use disorder subjects had significantly lower accuracy ( P < 0.01), while reaction times were significantly higher only in subjects of alcohol use disorder compared to controls ( P < 0.01) and opioid use disorder ( P < 0.01), reflecting working memory deficits of varying degrees in subjects with substance use disorders. Pre-stimulus EEG microstate revealed four topographic Maps 1-4: subjects of alcohol and opioid use disorder showing significantly lower mean duration of Map 3 (visual processing) and Map 2 (saliency and DMN switching), respectively, compared to controls ( P < 0.05)., Conclusion: Reduced mean durations in Map 3 and 2 in subjects of alcohol and opioid use disorder can underlie their poorer performance in Sternberg's task. Furthermore, cortical sources revealed higher activity in both groups of substance use disorders in the parahippocampal gyrus- a hub of DMN; superior and middle temporal gyri associated with impulsivity; and insula that maintains balance between executive reflective system and impulsive system. EEG microstates can be used to envisage neural underpinnings implicated for working memory deficits in subjects of alcohol and opioid use disorders, reflected by aberrant switching between neural networks and information processing mechanisms., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Psychiatry.)

Background: The current study was carried out owing to the projected increase in the fantasy sports market in India, the popularity of fantasy sports in the age group of 18-25 years, the gambling-related implications of engaging in fantasy sports, and the dearth of published data on the extent and pattern of engagement in fantasy sports among college students in India. We aimed to assess the attributes of engagement in fantasy sports among college students and explore their perceptions and attitudes toward fantasy sports., Methods: This was a cross-sectional observational study among students enrolled in undergraduate courses in an autonomous college in central India. The study questionnaire included a semi-structured proforma that asked for information on the sociodemographic details, questions to assess the gaming (both online and offline) pattern and participation in fantasy sports by the study participants, and a modified Motives for Online Gaming Questionnaire (MOGQ). The participants were also asked to express, on a 10-point scale, their agreement that fantasy sports are similar to gambling., Results: Around one-fifth of the participants had engaged in a fantasy sport at least once. Around 18% had gambled at least once. The participants who reported losing money from fantasy sports also engaged in a significantly greater number of fantasy sports ( p = .002). Those who engaged in fantasy sports with the main goal of making money agreed more with the statement that fantasy sports are similar to online gambling compared to those who did not ( p = .01)., Conclusions: Those who engaged in fantasy sports to make money agreed more with the statement that fantasy sports are similar to gambling. The study helps understand the associations between various psychosocial motives, monetary motivations, and involvement in fantasy sports., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2023 The Author(s).)

The United Nations Organizations observe various global public health days (GPHDs) (also known as world days) throughout the year. We aimed to assess the impact of GPSDs on online health information-seeking behavior related to substance use in the Indian context. We used the Google Trends data for this study using standard guidelines. We conducted a topic search for the query "Substance abuse" to capture online information-seeking behavior (OHISB) for substance use disorder-related searches. The data were analyzed using the Joinpoint Regression software. Joinpoint regression model analysis was conducted to determine the statistically significant daily percent change (DPC) in the RSV trend. We found that there were significant changes in OHISB for substance use-related disorders on the International Day Against Drug Abuse and Illicit Trafficking over the last five years. The increase in the pattern of online search for substance use-related information was not observed around the World No Tobacco Day, World Mental Health Day, and World Suicide Prevention Day. Since most of these world health days are likely to continue to be observed in the coming years, it is important to regularly assess their impact as well as make the necessary modifications to make them more effective in achieving the desired objectives., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Psychiatry.)

Objectives: Effective interventions for cannabis use disorders are fairly limited. The present randomized controlled trial (RCT) aimed to compare the reduction in cannabis use (number of days cannabis used) with brief intervention and simple advice in patients with cannabis use disorder., Materials and Methods: This non-blinded and parallel two-group RCT included 100 male patients with cannabis use disorder. A semi-structured pro forma and severity of dependence scale (SDS) were used. Participants were then randomized to either of the two arms (brief intervention and simple advice) in a 1:1 ratio. Cannabis use patterns and SDS scores were assessed over the phone at week 4, week 8, and week 12., Results: The two groups were comparable in sociodemographics and cannabis use characteristics. Participants in both groups were using cannabis for 30 days in the past month before enrolment. The brief intervention group had a lesser number of days of cannabis use vis-a-vis the simple advice group at 4, 8, and 12 weeks. There was a significant time effect for change in SDS scores (F = 30.629, P < 0.001), but the group effect was not significant (F = 0.379, P = 0.541)., Conclusion: In this population of regular cannabis users, brief intervention may be useful in reducing cannabis usage. It can be integrated into routine assessments and management of those with regular use of cannabis., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practice.)

Alcohol use is a major public health issue. It is also associated with a range of family, social, and economic problems. This led multiple countries worldwide to adopt national policies for alcohol regulation. Over the years, alcohol use and related problems have increased in India. The existing regulatory framework on alcohol varies greatly across states in terms of government sanctions, pricing, and legal drinking age, resulting in variations in its availability and prevalence of alcohol use disorder and related harms. Despite alcohol use being mentioned in several national policies and plans, a comprehensive national policy addressing alcohol is lacking. In this manuscript, the need for a dedicated national alcohol policy is underscored, emphasizing its potential to mobilize resources, prioritize interventions, and guide various stakeholders. The timely implementation of such a policy is crucial to address the multifaceted challenge of alcohol use effectively., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Psychiatry.)

Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although early maladaptive schemas (EMSs) have been suggested as potential vulnerability markers for alcohol dependence (AD), there is less emphasis on addressing these schemas in substance abuse treatment programs. We thus aimed to examine the change in schemas in response to cognitive therapy in individuals with AD., Methods: In this an open-label randomized controlled study, individuals with alcohol dependence syndrome (ADS, n = 84) were randomized to the intervention group ( n = 45), which received six cognitive therapy sessions combined with treatment as usual (TAU), or the control group ( n = 39), which was on TAU only. Participants were assessed on the measures of EMSs, alcohol use severity, and perceived stress at baseline and posttreatment., Results: The intervention group showed significant improvement in 5 out of 18 EMSs, that is, emotional deprivation, defectiveness, self-sacrifice, unrelenting standard, and negativity, compared to the control group, at the end of the treatment. There was a significant between-group effect for perceived stress but not for alcohol use severity., Conclusion: EMSs can be changed with cognitive therapy in individuals with AD and could be a crucial area to address in treatment programs. Further studies with long-term follow-up are warranted. The trial was registered with the Clinical Trials Registry-India (CTRI/2015/12/006441) on December 17, 2015., Competing Interests: The authors declared no potential conflicts of interest concerning this article’s research, authorship, and publication., (© 2022 The Author(s).)

Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: To assess recent changes in the extent and pattern of alcohol use in India using the National Family Health Survey (NFHS) data., Methods: We used unit-level data from both rounds of NFHS. The pattern of alcohol use was categorized as: 'almost every day', 'almost once a week' and 'less than once a week'. The information was segregated for the urban and rural settings. Information was also available on the type of alcoholic beverage used by the respondents. The z test for differences in proportions was carried out for the study variables., Results: Findings suggest a 22.37 and 39.02% reduction in the proportion of men and women who reported alcohol use, respectively. The proportion of men reporting 'almost every day' and 'about once a week' consumption of alcohol increased by 24.19 and 7.14%, respectively., Conclusions: With the caveats of expected limitations of surveys, the findings suggest an overall decrease in alcohol use in India, though the proportion of men with more frequent alcohol has increased. There is a need to strengthen the investment in the initiatives targeted at the harms due to alcohol use., (© The Author(s) 2022. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among the many challenges faced by the field of Psychiatry. The different philosophies and schools of thought about, and the sheer complexity of these highly prevalent clinical conditions make progress inherently difficult, not to mention the profusion of competing and sometimes contradictory terms that unnecessarily exacerbate the challenge. The lack of a standardized term adds confusion, fuels stigma, and contributes to a "wrong door syndrome" that captures the difficulty of not only diagnosing but also treating addictive and other mental disorders in an integrated manner. The World Association on Dual Disorders (WADD) proposes the adoption of the term "Dual Disorder" which, while still arbitrary, would help harmonize various clinical and research efforts by rallying around a single, more accurate, and less stigmatizing designation., (© 2022. The Author(s).)

Background: Alcohol use disorders (AUDs) leading to liver disease is major concern over other spectrum of disorder. Excessive alcohol consumption resulting in leaky gut syndrome is attributed to alcohol-induced liver injury through portal translocation of bacterial endotoxin. Susceptibility to alcoholic liver disease (ALD) in AUD patients could be dependent upon genes responsible for inflammation and alcohol metabolism. The pattern recognition receptor CD14 gene is a major player in endotoxin-mediated inflammation and susceptibility to ALD. This study investigated the genetic association of CD14 polymorphisms and other mechanisms relevant to altered inflammatory responses leading to ALD., Methods: Patients with alcohol use disorder with ALD (n = 128) and without liver disease (ALC, n = 184) and controls without alcohol use disorder (NALC, n = 152) from North India were enrolled. The CD4 gene polymorphisms in the North Indian population were evaluated by RFLP and sequencing. Secretory CD14 (sCD14), LBP, TLR4, MD2, TNFα, IL1b, IFNγ, IL6, IL10, and IL4 levels in serum were measured by ELISA among groups. The influence of polymorphisms on CD14 gene promoter activity and circulatory bacterial DNA level was determined., Results: The CD14 gene promoter and exonic region SNPs were found to be monomorphic, except for SNP rs2569190 for the North Indian population. The genetic association of SNP rs2569190(C/T) with the risk of developing ALD was found significant for TT genotype [OR TT , 95% CI = 2.19, 1.16-4.13 for ALD vs. ALC and OR, 2.09, 1.18-3.72 for ALD vs. NALC]. An increased sCD14 level was observed in AUD patients compared to NALC control. Increased levels of LBP, TLR4, TNFα, IL1β, IFNγ, and IL6 and reduced levels of MD2, IL10, and IL4 were observed among the ALD patients compared to the other two control groups. Elevated levels of pro-inflammatory and reduced levels of anti-inflammatory cytokines were observed in the risk genotype TT groups of ALD patients and the ALC group compared to NALC. Promoter activity was observed in the intronic region flanking SNPs and risk genotype can influence reporter activity, indicating CD14 gene expression., Conclusion: Enhanced CD14 expression associated with inflammatory responses increases susceptibility to ALD in the TT genotype of AUD patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Roy, Nadda, Kumar, Prasad, Kumar Jha, Pandey, Vanamail, Saraya, Balhara, Shalimar and Nayak.)

Competing Interests: None.

Aim: To investigate abnormalities in bone mineral density, trabecular bone score and vertebral fractures in male patients with alcohol use disorder to understand the impact on bone health., Methods: The study subjects included 134 male patients. Controls were 134 age matched healthy males. Assessments were made of the bone mineral density (BMD), trabecular bone score (TBS) and vertebral morphometry (VFA) for vertebral fractures. Biochemical measurements included serum total T4, thyroid stimulating hormone (TSH), parathyroid hormone (PTH) and 25- Hydroxyvitamin D 25(OH) D., Results: The mean BMD at total forearm, proximal forearm (or distal 1/3) and mid forearm was significantly higher in the alcohol use disorders (AUD) group than the controls (P < 0.01). Around 15% of patients with AUD had VFs compared with 9.0% of the healthy controls (P = 0.19). For each kg/m2 gain in body mass index (BMI), lumbar spine and total hip BMD increased by 0.009 and 0.014 g/cm2, respectively. Lumbar and hip BMD decreased by 0.002 and 0.003 g/cm2 per year increase in duration of alcohol used. For every 5 years increase in age of the patients the odds of having VFs increased by 39% (odds ratio 1.393 [95% confidence interval = 1.031-1.881, P = 0.03])., Conclusion: The findings of the current study suggest that persons with AUD in third and fourth decades of life, with BMI in normal range and with alcohol use disorder duration of around one decade might have no major alteration in BMD and TBS. Impact of alcohol use in this population was manifest by marginal increase in the prevalence of mild grade of vertebral fractures, mostly in the thoracic region., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally., Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation., Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well., Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue., Funding: None., Competing Interests: JP is funded by a National Health and Medical Research Council Investigator Grant (GNT1173126). DG receives funding support from the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust. He is an unpaid member of the UK Government's Department of Health and Social Care National Suicide Prevention Strategy Advisory Group, England and the COVID-19 response sub-group, an unpaid member of the Samaritan's Policy, Partnerships and Research Committee, and an unpaid member of the Movember Global Advisory Committee. LA has a research grant to Manchester University from Health Quality Improvement Partnership, on behalf of NHS England and devolved UK governments. He is also Chair, National Suicide Prevention Strategy Advisory Group, Department of Health and Social Care. SF was Special Advisor to a Coroner for a specific investigation and is Chairperson, New Zealand Mortality Review Committee. AB is supported by the EU Erasmus+ Strategic Partnership Programme (2019-1-SE01-KA203-060571). LFC is Primary Investigator for pesticide suicide research in Malaysia funded by the Centre of Pesticide Suicide Prevention Malaysia, University of Edinburgh (Oct 2020-31 March 2022). NK is Member, National Suicide Prevention Strategy Advisory Group (England) and Topic Advisor for NICE self-harm guidelines. NK also declares research grants paid to his institution by NIHR, HQIP and DHSC for work related to the treatment and prevention of suicidal behaviour (but not directly related to the current work). OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N); payment made to institution (KU Leuven). OJK reports grants from UCB Community Health Fund, outside the submitted work. The UCB Community Health funds in this case are managed and disbursed by the King Baudouin Foundation (Belgium). Selection is by an independent jury and UCB is not involved. Payment is to the institution (KU Leuven). OJK received a waived registration fee for the 2021 International Academy of Suicide Research (IASR) Summit in Barcelona (held online), as an invited speaker (unrelated to the current work). No payment was received directly. Fee was automatically waived at registration. OJK is a member of the Samaritans Research Ethics Board (SREB); this is an unpaid role. OJK is co-chair of the Early Career Group of the International Association for Suicide Prevention (IASP). This role is unpaid, but yearly IASP membership fee is covered in return for this service role. No funds are exchanged, but membership fee is covered directly by IASP. DK reports that the Wellcome Trust has supported the Elizabeth Blackwell Institute with a ISSF grant. DK also declares a grant from the Centre for Pesticide Suicide Prevention to conduct COVID-19 related work on self-harm in Sri Lanka, and panel fees from the Department of Health and Social Care for assessing grants. She also declares a leadership or fiduciary role with Migration Health and Development Research Initiative; no fees received. SL declares a $75,000 grant from Queensland Health; payment will be made to institution when payment occurs. SL also declares project funding from the Queensland Government for the Queensland Suicide Register; made to his institution. SL is also on the Technical Advisory Group (unfunded role), NSW Suicide Monitoring System. HO declares registration for the online congress DGPPN (2020 and 2021) and for the DGPPN congress (2019). He also declares registration for the congress OGPP (2019). SP declares a personal consultancy for support and advice to the National Office for Suicide Prevention (Health Service Executive, Dublin, Ireland) and a personal consultancy for support and advice to the National Suicide Prevention Leadership Group and the Scottish Government. SP also declares support from the World Health Organization for attending a workshop on National Suicide Prevention Implementation and Evaluation, Geneva, November 2019. SP also holds unpaid roles as adviser and committee chairmanships with the International Association for Suicide Prevention. GP is supported by the Flemish Government – Department of Health, Wellbeing and Family. AR and CR-L declare support by the Federal Health Ministry of Germany (BMG), grant number ZMVI1-2517FSB136. CR-L also declares payment or honoraria and participation on a Data Safety Monitoring Board or Advisory Board with Janssen and LivaNova. NR-V declares she is the designated representative of the Puerto Rico Department of Health in the Puerto Rico Administration of Mental Health and Anti-Addiction Services’ Mental Health and Addiction Council. It is not a paid position; she attends meetings as part of her responsibilities at the Puerto Rico Department of Health and is the Coordinator of the Public Policy Committee within this advisory council. The aforementioned council is a requisite with which the Puerto Rico Administration of Mental Health and Anti-Addiction Services must comply with because this Administration receives federal funding from the Substance Abuse and Mental Health Services Administration of the United States of America., (© 2022 The Authors.)

Background and Aim: Distance learning techniques are gaining popularity as the internet today is a faster and more convenient source of spreading exhaustive information. We aim at conducting a scoping review on the utility of internet-based learning in addiction psychiatry., Methods: We performed a systematic search of databases such as Google Scholar, PubMed, and Cochrane using the following keywords: Distance education, substance related disorder, teaching, internet, along with the MeSH terms ("Internet" AND "Teaching" AND "Substance Related Disorders") OR ("Distance Education" AND "Substance Related Disorders"). The reference lists of articles were searched for other relevant literature., Results: A total of 34 studies were included. Most of the courses offered online were on specific therapies, for example, training on motivational interviewing, twelve-step facilitation, cognitive behavioral therapy, alcohol screening, and brief intervention. They were based on various aspects of distance learning such as the acquisition of knowledge or skills, feasibility, level of satisfaction of the trainees/students, the cost-effectiveness of the techniques, and the type of trainees who have access to the course. The majority of the studies showed positive findings in terms of the parameter being studied. However, the level of satisfaction among the students is questionable., Conclusion: Internet-based teaching programs provide a good alternative to traditional educational methods in terms of effectiveness, feasibility, and acquisition of knowledge and skills. We emphasize the use of internet-based training in addiction psychiatry reinforced by actual practical experiences., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 Indian Psychiatric Society - South Zonal Branch.)

Background: The Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) is the most frequently used generic quality of life (QOL) measure in many countries and cultures worldwide. However, no single study has been carried out to investigate whether this questionnaire performs similarly across diverse cultures/countries. Accordingly, this study aimed to assess the cross-cultural measurement invariance of the Q-LES-Q-SF across ten different countries., Methods: The Q-LES-Q-SF was administrated to a sample of 2822 university students from ten countries: Bangladesh, Brazil, Croatia, India, Nepal, Poland, Serbia, Turkey, the United Arab Emirates, and Vietnam. The Bayesian approximate measurement invariance approach was used to assess the measurement invariance of the Q-LES-Q-SF., Results: Approximate measurement invariance did not hold across the countries for the Q-LES-Q-SF, with only two out of 14 items being non-invariant; namely items related to doing household and leisure time activities., Conclusions: Our findings did not support the cross-cultural measurement invariance of the Q-LES-Q-SF; thus, considerable caution is warranted when comparing QOL scores across different countries with this measure. Item rewording and adaptation along with calibrating non-invariant items may narrow these differences and help researchers to create an invariant questionnaire for reliable and valid QOL comparisons across different countries., (© 2022. The Author(s).)

Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Dysfunctional basic cognitions have been suggested as potential vulnerability markers for alcohol dependence (AD). Although there is a growing body of research on the role of distal cognitive vulnerability factors such as early maladaptive schema in the development of AD, little is known about the role of proximal cognitive factors such as cognitive distortions, dysfunctional attitude, and negative automatic thoughts., Methods: This comparative cross-sectional study aimed to examine dysfunctional cognitions in individuals with AD ( n = 84) in comparison with healthy individuals ( n = 60). The dysfunctional cognitions were assessed on the Young Schema Questionnaire third version of Short Form, Cognitive Distortion Scale, Dysfunctional Attitude Scale-Form A, and Automatic Thought Questionnaire. Multivariate analysis of covariance was conducted to analyze the group differences in dysfunctional cognitions., Results: After controlling for the group difference in employment status, 12 of 18 schemas were more prevalent in individuals with AD than in healthy individuals. Individuals with AD also scored higher on seven of 10 cognitive distortions, as well as in terms of dysfunctional attitude and negative automatic thoughts., Conclusion: Dysfunctional cognition may play a significant role in developing AD. The findings may enhance our understanding of the nature and severity of dysfunctional cognitions in the development of AD. The information may further assist the clinicians in implementing adequate intervention strategies to manage dysfunctional cognitions in individuals with AD., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 Indian Psychiatric Society - South Zonal Branch.)

Background: Studies and published reports have not commented on the change in the proportion of the Indian population that consumed alcohol over the years., Methods: We report the findings on changes in alcohol use in India over the past two decades, based on a secondary analysis of the data gathered over the successive National Family Health Surveys (NFHS-3 to 5)., Results: There was a significant decline (P < 0.001) of around 8% and 45% for the current use of alcohol among men and women from NFHS-3 to NFHS-4. There was a decline in the proportion of men reporting alcohol use across all but one state in NFHS-5 compared to NFHS-3. The decline was statistically significant (P < 0.001) for all but one state. There was a decline in the proportion of women reporting alcohol use in 12 states and an increase in three states. Also, there was a significant (P < 0.001) decline in the proportion of men reporting alcohol use in all the states in NFHS-5 compared to NFHS-4. There was an increase in the proportion of women reporting alcohol use in nine states (statistically significant in six states) in NFHS-5 compared to NFHS-4. However, the proportions were more than NFHS-3 values in two states., Conclusions: These observations on changes in alcohol use in the country over the past two decades will help better understand the trends in alcohol consumption and help better plan the future strategy to address alcohol use and alcohol use disorders., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 Indian Psychiatric Society - South Zonal Branch.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Aims: We conducted a cross-sectional survey to estimate the prevalence and clinical manifestation of disulfiram ethanol reaction (DER) and isopropanol toxicity (IT) in patients with alcohol use disorders, on disulfiram. Alcohol-based hand rub contains either ethanol or isopropanol or both. COVID-19 pandemic has led to wide scale usage of sanitizers. Patients with alcohol use disorders, on disulfiram, might experience disulfiram ethanol like reactions with alcohol-based sanitizers., Methods: We telephonically contacted 339 patients, prescribed disulfiram between January 2014 and March 2020. The assessment pertained to the last 3 months (i.e. third week of March to third week of June 2020)., Result: The sample consisted of middle-aged men with a mean 16 years of alcohol dependence. Among the 82 (24%) patients adherent to disulfiram, 42 (12.3%) were using alcohol-based hand rubs. Out of these, a total of eight patients (19%; 95% CI 9-33) had features suggestive of DER; four of whom also had features indicative of IT. Five patients (62.5%) had mild and self-limiting symptoms. Severe systemic reactions were experienced by three (37.5%). Severe reactions were observed with exposure to sanitizers in greater amounts, on moist skin or through inhalation., Conclusion: Patients on disulfiram should be advised to use alternate methods of hand hygiene., (© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment., Methods: This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD - ) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals., Results: About a fifth ( n =24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants ( n =8, 33.3%) were willing for the treatment of any kind, and only a half ( n =3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status., Conclusion: Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Psychiatry.)

Opioid use is a major problem in India and has high morbidity and mortality with a prevalence of 2.06%. There is a huge treatment gap for opioid use disorders (OUDs). Due to limited mental health resources and limited psychiatric training of medical practitioners in OUDs, a significant proportion of patients do not receive appropriate medical intervention. This article demonstrates how a primary care doctor working in a remote opioid substitution therapy (OST) clinic received assistance from the optional opioid module of clinical schedule for primary care psychiatry (CSP) and collaborative video consultation (CVC) module to address specific difficulties of patients already on Buprenorphine OST and improve the quality of care, thereby reducing chances of relapses. CVC module is a part of one-year digitally driven primary care psychiatry program designed by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The opioid module was designed by NIMHANS, Bengaluru in collaboration with the All India Institute of Medical Sciences (AIIMS), New Delhi These observations warrant replication of this approach across diverse settings and at a larger scale to explore and evaluate its impact and effectiveness., Competing Interests: Conflict of Interest None declared.

Background: The uncertainty about the impact of the lockdown in wake of COVID-19 on their future academic and carrier prospects, besides other concerns; makes college students, particularly vulnerable to stress during the COVID-19 pandemic. Gaming has been recognized as a coping mechanism against stress in the previously published literature., Objectives: The current study aimed to assess the gaming behavior of college students during the lockdown following COVID-19., Methods: Data were collected from a cohort of students that constituted the sampling frame of an ongoing project. A total of 393 college students were enrolled. All the eligible students were subsequently contacted through E-mail and WhatsApp messenger and invited to share the details., Results: About half (50.8%) of the participants reported that their gaming behavior had increased, whereas 14.6% reported a decrease in their gaming during the lockdown period. In binary logistic regression analysis, hours of gaming per day (odds ratio [OR] 1.75 [1.29-2.36]), increase in gaming due to examination related stress (OR 4.96 [1.12-21.98]), and belief that gaming helps managing stress (OR 4.27 [1.65-11.04]), were found to be independently associated with gaming behavior during lockdown period., Conclusion: In the lockdown period following COVID-19 pandemic, the increase in gaming behavior was associated with examination-related stress and the belief that gaming helps combat stress. These observations highlight the need to focus on the coping style of the students to ascertain the likelihood of them engaging in gaming behavior as a coping mechanism against stress., Competing Interests: None

In this endeavor, a novel electrochemical biosensor was designed using multiwall carbon nanotubes (MWCNTs)- and nickel nanoparticles (NiNPs)-embedded anandamide (AEA) imprinted polymer. The NiNPs so synthesized were mortared with MWCNTs and molecularly imprinted polymer (MIP), which enhanced sensitivity and selectivity of the developed sensor, respectively. The characterization methods of AEA-based MIP included X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and Brunauer-Emmett-Teller (BET) analysis, which supported the successful synthesis of the polymer. Electrochemical studies of fabricated sensor were performed using cyclic voltammetry (CV) and electrochemical impedance spectroscopy in potentiostatic mode (PEIS). In this first phase of AEA-specific sensor development, MWCNT/NiNP/MIP@SPE was found to successfully discriminate between different concentrations of AEA. The developed sensing platform demonstrated a 100 pM-1 nM linear range with a 0.01 nM detection limit (LOD), 0.0149 mA/pM sensitivity, and 50% stability within 4 months. The sensor demonstrated selectivity toward AEA: although acetylcholine (ACh) and dopamine acted as strong interfering components because of their chemical similarity, the spiked AEA samples demonstrated ∼90% recoveries. Hence, our results have passed the first step in AEA detection at home, although with a clinical setup, future advancement is still required., Competing Interests: The authors declare no competing financial interest., (Copyright © 2020 American Chemical Society.)

The management of painful diabetic neuropathy poses a tough clinical challenge. Although opioid analgesics are considered as second- or third-line agents in the management of moderate-to-severe neuropathic pain, prescription of opioids for this indication is higher than expected. This narrative review is a recommendation on how to ensure pragmatic use of opioids for those with painful diabetic neuropathy while avoiding complications such as opioid overdose, opioid diversion and the development of opioid-use disorder. Risk mitigation strategies at the level of the clinician include periodic assessment and documentation of clinical details, treatment history and psychosocial status. Using a multimodal approach to pain management, medication counselling, adherence monitoring programmes, evidence-based opioid dosing strategies and empowering patients to make treatment decisions are effective strategies in reducing risk associated with prolonged opioid use. At the organisational and policy level, using prescription drug monitoring programmes, carrying out periodic opioid utilisation reviews and providing training to patients and physicians on safe opioid use are useful, implementable strategies., Competing Interests: Disclosures: Yatan Pal Singh Balhara, Shalini Singh and Sanjay Kalra have no financial or non-financial relationships or activities to declare in relation to this article. Sanjay Kalra is a member of the journal’s Editorial Board., (© Touch Medical Media 2020.)

Introduction: The college students are prone to use internet in a manner that could negatively affect several aspects of their life. The present study is one of the largest studies to be undertaken in India, aimed at understanding the existing pattern of internet use and estimating the prevalence of problematic internet use (PIU) among college students., Materials and Methods: The Generalized Problematic Internet Use Scale 2 (GPIUS-2) was used to assess the PIU. Multiple linear regression analysis was conducted to ascertain the relationship between GPIUS-2 total score and demographic and internet use-related variables., Results: Of 3973 respondents from 23 engineering colleges located in the different parts of the country, about one-fourth (25.4%) had GPIUS-2 scores suggestive of PIU. Among the variables studied, older age, greater time spent online per day, and use of internet mainly for social networking were associated with greater GPIUS-2 scores, indicating higher risk for PIU. Students who used internet mainly for academic activities and during evening hours of the day were less likely to have PIU., Conclusion: This study suggests PIU among engineering college students in India is an important public health concern. There is a need to create awareness among students, emerging adults, parents, and concerned authorities about the harms associated with PIU. Furthermore, there is a need to implement preventive strategies for inculcating pattern of safe and healthy internet usage among them. In addition, there is a need to develop public health policies for prevention and treatment of PIU and conduct further research to enhance our understanding about the same., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Indian Journal of Psychiatry.)

Background: Suicide is a growing health concern and causes significant health burden. Patients with substance use disorders represent an especially vulnerable population in terms of self-harm. Data on risk factors for self-harm in substance-using population in the Indian context are limited. We aimed to determine the patterns and sociodemographic/clinical predictors of self-harm in patients with substance use disorders., Materials and Methods: We assessed 300 male patients on Deliberate Self-Harm Inventory to assess the patterns of self-harm. We performed mediation analysis to determine whether clinical variables acted via sociodemographic variables in their effect on self-harm., Results: The occurrence rate of self-harm was 32.7%. It was significantly associated with a younger age, being unmarried/separated, unemployed, history of injecting drug use, high-risk sexual behavior, and cannabis use disorders., Conclusion: Self-harm is an important consideration among patients with substance use disorders, and needs to be addressed by the clinicians involved in the care of such patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Indian Journal of Psychiatry.)

Objective: There is scarce literature available on the pattern of problematic internet use (PIU) and use of internet for mental health help-seeking among adult patients with psychiatric disorders in South-East Asian countries. The present study aimed to understand the pattern of PIU among adult patients attending the outpatient psychiatry services at a tertiary care center in India. Further, it aimed to explore the use of internet for seeking mental health-related information or services among them., Materials and Methods: This cross-sectional study recruited adult outpatients attending the outpatient psychiatry services following purposive sampling between June 2018 and December 2018. A semi-structured questionnaire was used to collect information regarding sociodemographic characteristics and internet use pattern of participants, including use of internet for various mental health-related purposes. The Generalized Problematic Internet Use Scale 2 (GPIUS-2) was used to assess the PIU. Statistical analysis was performed using SPSS version 23.0 software., Results: Among 155 study participants, 45 (29.03%) scored above 60 on GPIUS-2. Those with PIU were significantly younger, reported higher duration of daily internet use, and spent greater proportion of time online on activities related to social networking or social media than those with and without PIU. More than half of the participants reported internet use for seeking mental health-related information at least once in the past 1 month. There was no significant difference in the mental health-related internet use among adult patients with different psychiatric diagnoses, except for two situations. There was lesser use of internet for seeking information related to the symptoms of illness and various treatment modalities available among participants diagnosed with psychotic disorder. On the other hand, a greater use of internet for seeking information related to the symptoms of illness was reported by participants diagnosed with anxiety disorder., Conclusion: This study suggested that PIU is a frequently cooccurring condition among adult patients with primary psychiatric disorder. The importance of internet as a medium for seeking mental health information and services was observed among most of the study participants., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Tzu Chi Medical Journal.)

Background: In the extant literature, apart from few published case reports describing patients with severe form of gaming disorder (GD), there is a lack of studies describing the pattern and correlates of GD existing in the Indian settings. Thus, the present study aimed to explore the extent and pattern of gaming behavior in a sample of medical college students from India and explore its association with the sociodemographic, psychological (depressive symptoms), and Internet gaming characteristics., Materials and Methods: This Internet-based cross-sectional study was conducted as an online survey among 306 medical students by the Behavioral Addictions Clinic at a tertiary care teaching college in India. The severity of problematic gaming behavior and depressive symptoms was assessed using the Internet GD Scale-Short Form (IGDS9-SF) and Patient Health Questionnaire-9 (PHQ-9). A semi-structured questionnaire was used to collect information regarding sociodemographic and Internet gaming characteristics of the participants. Statistical analysis was done using SPSS software version 21.0, with two-tailed P < 0.05 taken as significant and P < 0.01 as highly significant results., Results: We identified 173 (55.6%) current gamers, with 11 (3.6%) Internet GD gamers based on the Diagnostic and Statistical Manual of Mental Disorders -5 criteria in the current study sample. A preference for multiplayer online gaming pattern (β =0.17, P = 0.005), spending greater amount of time in playing digital games (β = 0.53, P < 0.01), and higher PHQ-9 scores (β =0.25, P < 0.01**) representing greater depressive symptom severity were associated with statistically significantly greater scores on the IGDS9-SF, indicative of a higher risk for having GD., Conclusions: GD is a cause of concern among medical students in India. There is an urgent need to create awareness about it among students and concerned authorities. Further, there is a need to develop effective screening and treatment strategies suited for our population. The risk factors identified in the current study can be utilized to screen those at high risk of developing the same., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Industrial Psychiatry Journal.)

Background: In view of recent global opioid epidemic and scarcity of literature assessing the quality of life (QoL) and stigma among opioid use disorder (OUD) patients, this study aimed to assess the overall QoL and examine its relationship with perceived stigma among them., Materials and Methods: This cross-sectional study assessed patients with OUD at a tertiary care centre. QoL was assessed using the World Health Organization Quality of Life-brief version, whereas perceived stigma was measured using the Perceived Stigma of Substance Abuse Scale (PSAS)., Results: Among 168 patients with OUD, all the four domain-wise scores of physical health ( r = 0.79, P < 0.01), psychological health ( r = 0.87, P < 0.01), social relationships ( r = 0.78, P < 0.01) and environment ( r = 0.80, P < 0.01) QoL correlated significantly with average score, with maximum impairment noted in the social domain. The mean PSAS score was 21.19 ± 2.99, with perceived stigma found to be significantly associated with impairments in the physical (β = -0.28, P < 0.01), psychological (β = -0.27, P < 0.01) and environment (β = -0.21, P < 0.01) domains of QoL. Furthermore, being employed was significantly associated with impairment in the social domain of QoL (β = -0.17, P = 0.02)., Conclusion: OUD similarly affects all the four domains of QoL, with a higher level of perceived stigma associated with significantly poorer QoL in the physical, psychological and environment domains. However, future studies assessing different forms of stigma and QoL among patients with OUD are needed to confirm and better characterise the findings of this study., Competing Interests: There are no conflicts of interest.

Opioids are one of the most common illicit psychoactive substances being used in India. In fact, opioid use disorders are the most common disorder presenting to the substance use disorder treatment centers across the country. Effective and evidence-based interventions are available for management of opioid use disorders. However, the treatment for opioid use disorders remains difficult to access for most of those in need in India. The current article presents the literature on the use of tramadol for the management of opioid use disorders. It also makes recommendations on the use of tramadol for the management of opioid use disorders. Tramadol offers a viable alternative to the existing options for the management of opioid use disorders. It has been found effective when used for this indication. It offers certain major advantages such as easy and wide availability and low abuse liability. It offers a good option to expand the treatment services for opioid use disorders across the country., Competing Interests: There are no conflicts of interest.

Problematic Internet use (PIU) among students has become a significant mental health concern. Our goals were to review the existing studies on problematic Internet from Southeast Asian Region and examine: the prevalence for PIU among students; explore for sociodemographic and clinical correlates; and assess the physical, mental, and psychosocial impact of PIU in this population. All studies conducted among population of the Southeast Asia, involving students (school students to postgraduate students) of any age which explored etiological factors and/or the prevalence or any other factor associated with PIU/Internet addiction were considered eligible for the present review. The electronic databases of PubMed and Google Scholar were systematically searched for the relevant published studies up to and including October 2016. Our search strategy yielded 549 articles, 295 of which were eligible for screening based on their publication in English language in a peer-reviewed journal. Of these, a total of 38 studies met the inclusion criteria and were included in the review. The prevalence of severe PIU/Internet addiction ranged from 0 to 47.4%, whereas the prevalence of Internet overuse/possible Internet addiction ranged from 7.4% to 46.4% among students from Southeast Asia. Physical impairments in the form of insomnia (26.8%), daytime sleepiness (20%), and eye strain (19%) were also reported among problem users. There is a need to conduct further research in this area to explore the protective and risk factors associated with it and also longitudinally assess the trajectories of the outcome., Competing Interests: There are no conflicts of interest