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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

Purpose: To explore whether the 'hikikomori' syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated.Methods: Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment.Results: Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents' felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization.Conclusions: Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco is a well-established risk factor for cancer, but its association with other morbidities needs consideration. The low-income and middle-income countries (LMICs) with unprecedented demographic transformation lack evidence on tobacco use and its impact on cognitive health., Aims and Methods: Using a propensity score matching approach, we utilized data from the Longitudinal Ageing Study of India. Study employed 1:1 nearest neighbor matching with the replacement methodology. We estimated the odds of the poor cognitive score and tobacco use among older adults based on five different models for ever tobacco user, former tobacco user, current tobacco user, current smokers, and current smokeless tobacco users with reference to never tobacco users., Results: The estimated average treatment effect for the treated and the untreated group has shown a higher likelihood of cognitive decline among ever (OR -0.26; 95%CI -0.43 to -0.09), current (OR -0.28; 95%CI -0.45 to -0.10), and former (OR -0.53; 95%CI -0.87 to -0.19) tobacco users compared to never tobacco users. The finding further suggests the odds of lower cognitive scores among older adults who were smokers (OR -0.53; 95%CI -0.87 to -0.19) and smokeless tobacco users (OR -0.22; 95%CI -0.43 to -0.01) as compared to never tobacco users., Conclusions: Interventions designed to prevent the incidence of cognitive impairment should focus on limiting the use of tobacco. Strategies under the tobacco-free generation initiative should be amplified in order to prevent future generations from productivity loss, premature ageing and to promote healthy aging., Implications: Evidence of a definitive association between tobacco consumption and cognition among older adults is sporadic in LMICs. Though tobacco is a risk factor for various diseases including cancer, the extent of its impact on cognitive health among the older population is limited. This study contributes to the existing literature by highlighting poor cognitive outcomes among older adults who smoke tobacco and/or consume smokeless tobacco as compared to never-tobacco users. Our findings emphasize the need to accelerate programmes related to tobacco-free generation in LMICs to reach a higher quality of life and healthy aging in pursuit of achieving the sustainable development goal of "good health and well-being.", (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Depression and diabetes share a bidirectional causal association. Additionally, during the postpartum period women have an increased vulnerability for both depression and impaired glucose tolerance. The impact of the comorbidity of diabetes and postpartum depression is also bidirectional with an impaired course and outcome of both these disorders. The clinic visits for pregnancy and/ or diabetes care offer important opportunity to screen for postpartum (as well as prepartum) depression. Screening tools that are shorter, that take less time and acceptable are recommended. While a limited number of guidelines on management of depression among persons with diabetes have commented on management of the postpartum depression, the emphasis is on timely intervention using pharmacological and psycho- social interventions. There is a need to develop a collaborative approach involving various stakeholders to effectively manage postpartum depression and diabetes.

There is a gap in existing literature regarding Over the Top (OTT) platform use contributing to the excessive and problematic screen time. We aimed to assess OTT platform use among college students and its associations with increased screen time, mental well-being, COVID-19 related anxiety and personality traits. A total of 1039 students from a college in India were invited to participate in this web-based survey. A majority of participants used OTT platforms regularly. Subscription to paid OTT platforms, poor mental well-being were associated with problematic OTT use; whereas personality trait of conscientiousness seemed to offer protection against problematic OTT use.

Background and aims Opioid dependence is a chronic, relapsing substance use disorder with a multifactorial etiology, including a genetic component. Serotonin pathway gene polymorphisms have been an important focus of research for psychiatric disorders, including substance use disorders. This study aimed to identify the association of serotonin pathway gene polymorphisms with self-harm, depressive symptoms, impulsiveness, and aggression in patients with opioid dependence. Method The study group comprised 366 subjects with opioid dependence and 200 healthy volunteers. Patients were assessed for a history of self-harm, depressive symptoms, impulsiveness, and aggression using standard tools. Genomic DNA was used for genotyping of four polymorphisms - 5-HTTLPR, STin2 VNTR, TPH1 A218C, and TPH2 G703T. Results The short allele of 5-HTTLPR polymorphism showed a significant difference between cases (59.8%) and controls (40.1%) ( p =0.001) and revealed an association with age at opioid dependence ( p =0.033). There was a borderline significance of the short allele of 5-HTTLPR with the duration of opioid use ( p =0.061) and non-plan impulsivity ( p =0.076), suggesting a role of 5-HTTLPR in the susceptibility of opioid dependence. The other markers did not differ between cases and controls. However, the STin2A polymorphism revealed a significant association with anger scores, which may indicate its role in aggressive behavior. Conclusions The present study, the first of its kind, suggests an association of 5-HTTLPR polymorphism with opioid dependence and STin2A polymorphism with aggressive behavior among opioid-dependence patients, signifying the role of these markers in our patient population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sarkar et al.)

Objective: The purpose of this study was to assess and compare neurological soft signs in patients of cannabis use disorder (CUD) with and without co-occurring psychosis in a treatment-seeking sample., Methods: We included 30 right-handed male subjects aged 18-65 years diagnosed with CUD (as per DSM-5) without any co-occurring psychiatric disorder in group I and those with co-occurring non-affective psychosis in group II. Group III consisted of 30 age and sex-matched, right-handed, healthy subjects with no psychiatric or medical conditions. Neurological Evaluation Scale (NES) was applied to measure neurological soft signs across the groups. We also used the Severity of Dependence Scale (in CUD with or without co-occurring non-affective psychosis groups) and Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Barnes Akathisia Rating Scale, Abnormal Involuntary Movements Scale, and Simpson Angus Scale (in CUD with co-occurring non-affective psychosis group) ., Results: Our data suggested higher total NES mean scores in CUD with (20.53 ± 13.77) or without co-occurring non-affective psychosis groups (15.93 ± 9.86) as compared to healthy controls (6.20 ± 5.40) ( χ 2  = 23.12; p  < .001). However, there were no differences between cannabis use disorder with or without co-occurring non-affective psychosis groups. The mean of subdomain scores of motor incoordination, sequencing of complex motor tasks, sensory integration, and others was significantly higher in CUD with or without co-occurring non-affective psychosis groups compared to healthy controls., Conclusion: Impairment in neurological soft signs is present in patients with CUD regardless of a co-occurring psychosis. Cannabinoids might be interacting with the brain circuits known to be involved in schizophrenia.

Objective: The COVID-19 pandemic has posed a great challenge for the existing health systems. The restrictions imposed across countries on the movement of people and the realignment of health care services in response to the pandemic are likely to negatively affect the health status and delivery of mental health services to persons with dual disorders (PWDD). Methods: An online survey was conducted among mental health professionals involved in providing care to PWDD to better understand the problems encountered and identify potential solutions in providing continued treatment for PWDD during the COVID-19 pandemic. Results: The findings confirmed significant disruption in the delivery of treatment services for PWDD during the COVID-19 pandemic. Dissatisfaction with personal protective equipment, inadequate COVID-19 testing services at treatment facility, and lack of guidelines on providing continued treatment services to PWDD by national authorities or professional bodies were identified as the likely reasons for this disruption. Conclusions: These concerns in turn need to be addressed by the policy-makers, hospital management staff, and other stakeholders. Specifically, there should be a focus on developing and disseminating guidelines to assist mental health professionals in setting-up and providing continued treatment services to PWDD via tele-psychiatry and other novel digital strategies.

National estimates on tobacco and alcohol consumption are insufficient to guide policy at the sub-national level. This study assessed the sex-stratified prevalence of different types of smoking and smokeless tobacco and alcohol consumption among adults aged 15-49 using the National Family Health Survey (2015-16) at sub-national administrative units. Three-level logistic regression models were applied to quantify the variation at district- and community-level in smoking and consumption of smokeless tobacco and alcohol. A higher prevalence of smoking, smokeless tobacco and alcohol consumption was observed among men. The study found that the considerable unexplained variations in two different forms of tobacco and alcohol consumption among men attributed to between-population differences at district-level and community-level. The between-population differences were even larger at the district- and community-level in tobacco and alcohol consumption among women. Continious assessment of tobacco and alcohol consumption at lower administrative units and the development of evidence-based localised cessation interventions must be integrated with health policy to reduce disease burden and preventable deaths., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background & Objectives: Working memory impairments in the subjects of opioid addiction may stem from an aberrant cortical activity in the executive areas, and may help in early identification of individuals with addictive tendencies and may also be used as a neurofeedback mechanism in adjunct to the existing therapeutics., Methods: Electrical neuroimaging via 128-channel electroencephalography (EEG) recording was done in 15 male subjects with opioid addiction (29.45±5.6 yr) during the performance of Sternberg Working Memory Task. EEG data were acquired and analyzed for cortical sources during task as compared to resting (baseline) condition., Results: Working memory deficits were manifested as decrease in accuracy percentage in the subjects with opioid addiction, while no significant difference was seen in reaction time, on comparison with laboratory-acquired matched controls. Standardized low-resolution brain electromagnetic tomography (sLORETA)-based EEG source analysis revealed higher cortical activity in the anterior cingulate cortex, inferior, middle and superior temporal gyri, inferior frontal gyrus, superior parietal lobule, inferior parietal lobule and precuneus, whereas significant lower activity was seen in superior and middle frontal gyri, parietal lobule, cingulate cortex and pre- and postcentral gyri when the task was compared to baseline in the subjects with opioid addiction. Further, a negative correlation was seen between the accuracy of task performance and activation ratio for the significant gyri in the subjects with opioid addiction., Interpretation & Conclusions: EEG cortical sources revealed the failure of deactivation of default-mode network (DMN) during the task amongst the subjects with opioid addiction. In addition, there was a decrease in the executive function areas in the subjects with opioid addiction. This lack of sufficiently active executive network and persistence of DMN during the task (as compared to baseline) may potentially form the basis of functional impairments in the subjects with opioid addiction., Competing Interests: None

This article reviews the provisions of Indian national policy on narcotic drugs and psychotropic substances in context of the health sector services for (illicit) psychoactive substances and substance use disorders (SUD). For the the current review, a checklist was developed based on recommendations from various agencies and organizations. The document on Indian national policy on narcotic drugs and psychotropic substances was reviewed based on the checklist. Themes such as identification in the aims/objectives/vision of the policy, including those highlighting treatment-related needs for SUD; establishment of minimum standards of care for treatment; evaluation of treatment programs for SUD; government regulation of public and private drug treatment services; capacity building for treatment services; and harm reduction services to reduce bloodborne infections were documented in the policy. Others such as transparency of the policy making process; situation analysis; implementation of substance abuse prevention and treatment programs that target key populations; impetus on evidence-based programs and practices were inadequately documented. Finally, integration of treatment into existing health care systems; services for co-occurring disorders (medical and psychiatric); monitoring and performance evaluation of prevention programs; harm reduction services to reduce overdose; budget allocations and provisions for implementation were not documented in the current policy.

Diabetes distress can be managed effectively by coping-skill training. To improve coping skills, one must begin by analysing current coping styles of an individual. The GlucoCoper has been developed as a brief, simple, easy-to-administer tool for assessing the coping mechanism of people with diabetes mellitus. The GlucoCoper includes six items rated on a graphic visual analogue scale. These include four items to assess positive coping skills (acceptance, optimism, planning and action) and two items to assess negative coping mechanisms (negativity and blame). The current single centre prospective study analysed the six-item GlucoCoper as a tool to identify coping skills in antenatal women with diabetes, and correlated them with level of diabetes distress. Greater duration of diabetes was related with lower optimism; while poor glycaemic control (high glycated haemoglobin [HbA1c]) was related with high negativity and low scores for planning. Highly educated subjects revealed greater negativity, while those from a rural background exhibited higher blame scores of =7.00 for negativity, =4.00 for planning, and =5.00 for action. These factors should prompt detailed evaluation and intervention. The findings of the current study suggest that GlucoCoper can be used as a screening tool for dysfunctional coping skills in pregnancy complicated by diabetes. Negativity, planning and action, the three domains which correlate strongly with the GlucoCoper score, can be used to create a three-item GlucoCoper, to be used as a brief and effective screening tool for dysfunctional coping skills in pregnancy complicated by diabetes., Competing Interests: Disclosure: Bharti Kalra, Sanjay Kalra, Yatan Pal Singh Balhara, Komal Verma, AAS Azam and Fouzia A Shaikh have no conflicts of interest to declare in relation to this article.

Introduction : Well-structured instructions for authors in journals help researchers in reporting unbiased results, which subsequently facilitates the review process. There have been reports of systematic evaluations of instructions for authors from journals in various medical specialties. However, precise information on the nature and extent of these instructions for authors in addiction science is lacking. Hence, this study systematically evaluated the instructions for authors for journals in addiction science. Methods : A total of 1139 journal titles were retrieved across multiple databases. Finally, 88 exclusive titles fulfilling the eligibility criteria were considered in this study. The four domains evaluated were journal characteristics, reporting, statistical reporting, and ethical requirements. Results : More than half of the journals were published by academic institutions or professional societies. Less than one-fourth of the journals endorsed adherence to various reporting guidelines and endorsed the Consolidated Statements on Randomized Controlled Trials guidelines to the maximum level (14.8%). Approximately, half (48.9%) of the journals had a separate section on "statistical analysis." The various parameters of statistical reporting were suboptimally endorsed. Conclusion/Importance : The instructions for authors in addiction science journals provide insufficient information in various domains. There is an urgent need to improve the author instructions segment of addiction science journals so that the process of research dissemination can occur more effectively. A higher rate of endorsement of various reporting guidelines and statistical reporting may help to minimize reporting bias as well as prevent unnecessary delays in the publication of important research findings.

Background: Certain limitations of the existing opioid substitution therapies necessitate exploration of other options for maintenance of patients with opioid dependence. This study aimed to present the experience of use of tramadol for long-term treatment of patients with opioid dependence., Methods: This was a cross-sectional interview-based observational study conducted in Uttar Pradesh state in India. Patients with opioid dependence who received oral tramadol treatment for a period of more than 6 months were recruited. Outcome was assessed in terms of self-reported abstinence on tramadol., Results: A total of 102 participants were recruited in the study, with a mean age of 41.3 years. All the participants were males. Abstinence to extraneous opioids was reported by 58.8% of the sample, and the median dose of tramadol at which abstinence was achieved was 350 mg/d. Those who reported to be taking natural opioids (raw opium or poppy husk) at the time of seeking treatment had higher rates of achieving abstinence., Conclusions: Tramadol may be a possible option for the maintenance treatment among some opioid-dependent individuals. Further studies are required to establish its efficacy vis-à-vis other medications used in opioid substitution treatment.

In spite of various psychoactive substances (including tobacco, alcohol, and opioids) being closely associated with development of metabolic syndrome (MS), little research exists on the prevalence of MS among persons with addictive disorders. The criteria used to diagnose MS varied across these studies, and part of the variation in the prevalence rate (5.1%-30.6%) could be attributable to this fact. The current study aimed to assess the prevalence of MS in patients with alcohol dependence syndrome (ADS) and opioid dependence syndrome (ODS) using revised National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP-III) criteria and International Diabetes Federation (IDF) criteria. We tried to assess the impact of the choice of the diagnostic criteria on the prevalence rate of MS in the persons with ADS and ODS. This was a cross-sectional observational study. Semi-structured pro forma was used to collect information on the sociodemographic profile and clinical profile. Anthropometric measurements included waist circumference, height, weight, and body mass index (BMI). The systolic and diastolic blood pressure, fasting blood sugar (FBS), serum triglycerides, and serum high-density lipoprotein were measured. Patients were diagnosed as having MS by using revised NCEP ATP-III and IDF criteria. Statistical analysis was done by Chi-square (Fischer's exact test), independent sample Student's t -test, and Cohen's kappa. Among the individuals with ADS, the prevalence of MS was found to be 20.8% and 9.9% according to revised NCEP ATP III criteria and IDF criteria, respectively. Among individuals with ODS, the prevalence of MS was found to be 20.3% and 5.1% according to revised NCEP ATP III criteria IDF criteria, respectively. While there was a good degree of concordance between IDF and modified NCEP-ATP III criteria for MS for ADS ( n = 256) (κ = 0.649, P < 0.001), the concordance was only fair for ODS (κ = 0.333, P < 0.001). The findings of our study thereby support the recommendation that revised NCEP ATP-III criteria is better choice than IDF criteria for identification of MS in individuals having addictive disorders, especially opioid dependence., Competing Interests: There are no conflicts of interest.

The Shrimad Bhagavad Gita enlightens everyone on how to cope up with various situations in life. It uses the conversation between Lord Krishna and Arjuna to highlight initial negative coping mechanisms exhibited by the latter. It goes on to showcase positive coping skills suggested by Lord Krishna and implemented by Arjuna. The Bhagavad Gita, through this "case-based methodology," teaches us how to cope with a demanding situation. Diabetes is a lifestyle disease, which warrants a thorough change in one's lifestyle, including changes in basic activities such as diet and exercise. This brief communication utilizes the teachings of Bhagavad Gita to help in coping with illness, especially chronic illness such as diabetes. The article cites verses from the Bhagavad Gita to show how one may cope with the stress of illness such as diabetes., Competing Interests: There are no conflicts of interest.

The vital signs are an integral part of clinical methods. In diabetes, determination of plasma glucose can be taken as the fifth vital sign. The sixth vital sign is well being, which can easily be measured by two item questionnaires designed to assess distress, depression and coping skills. This sign is essential for the screening and follow up of persons living with diabetes, as it provides an idea of quality of care, helps plan therapeutic interventions, and serves as a surrogate for prognosis or outcome. Inclusion of the sixth vital sign reflects the relevance of the bio-psychosocial model of health to diabetes care.

This article discusses a comprehensive approach to the management of diabetes distress. It mentions the screening and diagnosis of diabetes distress, and discusses its etiopathogenesis, investigations and management strategies in detail. The management of diabetes distress, termed as diabetes therapy by the ear, is based upon four pillars: strengthening of self-care skills, optimization of coping skills, minimizing change-related discomfort, and utilization of external support. The article describes coping skills training and change-related discomfort mitigation in detail.

This communication focuses on an important, yet neglected, aspect of medicine, which has an impact on diabetes care as well. Betel quid (paan) chewing is a commonly encountered, socioculturally accepted, "culture-bound" addictive disorder. Betel quid chewing has unwanted psychotropic, carcinogenic and dysmetabolic effects. Thus, it should be discouraged as strongly as tobacco use. This communication calls for raised awareness among physicians and community leaders regarding this addictive disorder, and highlight the need for research on this topic.

Both diabetes and drug addiction are common phenomena across the world. Drug abuse impacts glycaemic control in multiple ways. It becomes imperative, therefore, to share guidance on drug deaddiction in persons with diabetes. The South Asian subcontinent is home to specific forms and patterns of drug abuse. Detailed study is needed to ensure good clinical practice regarding the same. This communication provides a simple and pragmatic framework to address this issue, while calling for concerted action on drug deaddiction in South Asia.

Background: "Dual disorder" or "dual diagnosis" refers to the co-occurrence of substance use disorder and psychiatric disorders. Prospective studies have shown that treatment outcomes, such as symptom levels, hospitalization rates, housing stability, and functional status, are worse among the patients with dual disorders as compared with those who have either of these disorders., Objectives: The current article is aimed at reviewing the current state of evidence on neurobiology of dual disorders. Given the high prevalence of co-occurrence of substance use disorder and psychiatric disorders, it is important to explore the various facets of this association. The current review assimilates the information on neurobiological research on dual disorders and helps the readers gain insights into the current understanding on this theme., Methods: The electronic database of PubMed was searched for relevant publications., Results: The studies included in the review belonged to various domains of neurobiology including neuropathology, structural neuroimaging, functional neuroimaging, genetics, neurochemicals/neuroreceptors, and neuroendocrinology. Forty studies were included in the review., Conclusions: Most of the issues related to the neurobiology of dual disorders remain inadequately studied. However, the current evidence suggests that the individuals with co-occurring disorders are likely to differ from those with either substance use disorders or psychiatric disorders alone on various neurobiological aspects. Hence, it is imperative to systematically study the various neurobiological aspects of dual disorders in the future.

BACKGROUND ‘‘Dual disorder’’ or ‘‘dual diagnosis’’ refers to the co-occurrence of substance use disorder and psychiatric disorders. Prospective studies have shown that treatment outcomes, such as symptom levels, hospitalization rates, housing stability, and functional status, are worse among the patients with dual disorders as compared with those who have either of these disorders. OBJECTIVES: The current article is aimed at reviewing the current state of evidence on neurobiology of dual disorders. Given the high prevalence of co-occurrence of substance use disorder and psychiatric disorders, it is important to explore the various facets of this association. The current review assimilates the information on neurobiological research on dual disorders and helps the readers gain insights into the current understanding on this theme. METHODS: The electronic database of PubMed was searched for relevant publications. RESULTS: The studies included in the review belonged to various domains of neurobiology including neuropathology,structural neuroimaging, functional neuroimaging, genetics,neurochemicals/neuroreceptors, and neuroendocrinology. Forty studies were included in the review.Conclusions: Most of the issues related to the neurobiology of dual disorders remain inadequately studied. However, the current evidence suggests that the individuals with co-occurring disorders are likely to differ from those with either substance use disorders or psychiatric disorders alone on various neurobiological aspects. Hence, it is imperative to systematically study the various neurobiological aspects of dual disorders in the future.

Background and Objectives: Alcohol use is a major risk factor for global disease burden, and excessive use leads to disability in the individual. This study aimed to assess the disability and its correlates among individuals with alcohol use disorders (AUDs). In addition, it assessed the quality of life measures in this population group., Methodology: A cross-sectional study on a sample ( N = 62) from among treatment seekers for alcohol dependence. Diagnostic and Statistical Manual, Fifth Edition (DSM-5) criteria were used to assess disorder severity. The WHO Disability Assessment Schedule (WHODAS) 2.0 and World Health Organization Quality of Life-BREF were used to assess disability and quality of life, respectively. Descriptive statistics, correlation analysis, and linear regression analysis were used for comparative assessments. The level of statistical significance was kept at P < 0.05 for all the tests., Results: DSM-5 diagnosis of the individuals suggested a high severity of substance use disorder as an average of 8.8 (±1.8) criteria were fulfilled. WHODAS 2.0 revealed maximum disability in the domains of "participation in the society," "household and work-related activities" and "cognitive functioning." The quality of life measures indicate poor physical health, reduced work capacity, and cognitive dysfunction. A negative correlation was seen between the social dimensions of disability (getting along) and quality of life measures of psychological health ( P = 0.026) and social relationships ( P = 0.046), work domain of disability schedule and physical health score on quality of life evaluation ( P = 0.001). Older age had greater impairment in the work domain ( P = 0.040), and unemployment was associated with higher disability ( P = 0.001). Unemployment and duration of alcohol use were the independent predictors of greater disability., Conclusions: Disability assessment using WHODAS 2.0 shows significant impairment in individuals with AUDs that is negatively correlated with quality of life measures., Competing Interests: There are no conflicts of interest.

Aim: To examine the prevalence and pattern of comorbidity in alcohol dependence and its relationship with physical and laboratory findings., Materials and Methods: Eighty males with alcohol dependence were examined using the Hindi version of Diagnostic Interview for Genetic Studies, the International Classification of Disease-10 th Edition Personality Disorder Examination, Alcohol Use Disorder Identification Test for alcohol use, global assessment of functioning, blood sampling electrocardiogram, and ultrasonogram., Results: Eighty-seven percent had a comorbid Axis I or an Axis II psychiatric disorder, over 78% had nicotine dependence, and 56% had comorbid Axis II disorder, antisocial personality being the most common. Gamma glutamyl transpeptidase levels were significantly associated with comorbidity., Conclusions: High comorbidity of Axis I psychiatric disorders was found among persons with alcohol dependence. Axis II disorders were also present.

Background: Cannabis continues to be the most commonly used illicit psychoactive substance globally. The National Survey in India conducted in the year 2004 also reported it to be the most commonly used illicit substance in the country. Furthermore, it was reported to be the second most commonly used psychoactive substance by the treatment seekers at de-addiction centers in the country., Objectives: To assess time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years., Materials and Methods: The study utilized data collected through Drug Abuse Monitoring System across India. The data of treatment seekers from de-addiction centers established under the Drug De-addiction Program, Ministry of Health and Family Welfare, Government of India and supported by the Ministry of Social Justice and Empowerment, Government of India (122 in number) across the country were analyzed., Results: A total of 107,469 individuals sought treatment from government de-addiction centers over the 7 years (2007-2013) period. With the exception of an aberration for the year 2012, there has been a steady decline in the proportion of treatment seekers who are not current cannabis users. A significantly greater proportion (Chi-square: 586.30, df: 1, P < 0.001) of individuals with current cannabis use alone or along with tobacco (20.4%) tend to have a co-morbid psychiatric disorder as compared to treatment seekers with current use of substances other than cannabis (6.1%)., Conclusions: It is important to focus on cannabis in clinical service delivery and research in the country.

Background and Aims: Engagement into treatment is crucial for improving outcomes among patients with substance use disorders. This study aimed to find the rates and characteristics of treatment noncompletion in patients who were admitted to a drug dependence treatment center in north India., Methods: This retrospective record review analyzed data from consecutive patients admitted between January 1, 2014, and December 31, 2014, at the National Drug Dependence Treatment Centre, Ghaziabad, India. The type of discharge was discerned from the records, along with selected demographic and clinical characteristics of the patient., Results: A total of 942 in-patients were included in the analysis, 936 (99.4%) of whom were males. The mean duration of ward stay was 12.7 (±8.1) days. Of the 942 patients, 779 (82.7%) completed the inpatient treatment while 163 (17.3%) did not complete (n = 95, 10.1% were discharged against medical advice; n = 44, 4.7% were discharged on disciplinary grounds and n = 24, 2.5% absconded or left without intimation). The inpatient treatment noncompleters had a shorter duration of ward stay (8.3 ± 6.9 days vs. 13.6 ± 8.0 days, P < 0.001), were of a greater average age (33.1 ± 10.0 years vs. 30.5 ± 9.4 years, P = 0.002), were more likely to be dependent on opioids (71.2% vs. 59.1%, P = 0.004) and less likely to be dependent on alcohol (30.1% vs. 42.9%, P = 0.002) than treatment completers., Conclusion: Understanding the characteristics of patients with substance use disorders who do not complete inpatient treatment may help in identifying those at-risk of having poor outcomes. Efforts are required to address their concerns so that the overall patient outcomes can be improved.

Objective: This article overviews training, clinical services, and research on dual disorders across four countries: France, India, Israel, and Spain., Methods: The current dual disorders systems in each of the four countries were reviewed, with a focus on strengths and limitations of each., Results: In France, psychiatric care occurs within the public health care system and involves little training of medical graduates for managing dual disorders. Special courses and forums for specialists have recently started to meet the growing interest of physicians in learning how to manage dual disorders. The Indian health care system grapples with a large treatment gap for mental disorders, and while some treatment services for dual disorders exist, specific research and training efforts on dual disorders are just beginning. Israel has both public- and private sector services for patients with dual disorders, with specialized inpatient and emergency care for the acutely ill as well as day care and therapeutic communities for long-term management. Interest by researchers is growing, but training and education efforts in dual disorders are, however, minimal. Similar to the other countries, addiction and psychiatry disciplines are governed by separate divisions within the National Health System in Spain. There are some dual disorders services available, but they are limited in scope. While medical professionals clearly recognize the importance of dual disorders, there is no such recognition by the national and regional governing bodies., Conclusions: The common thread in various aspects of dual disorder management in each of these four countries is that there is a lower-than-desirable level of attention to dual disorders in terms of care, policy, research, and training. There are growing opportunities for training and continuing education in dual disorders management. We suggest that nations could learn from each other's experiences on how to address the issue of dual disorders.

Consumption of tobacco has been a worldwide problem over the past few decades due to the highly prevalent tobacco-attributable complications. Tobacco use has also been found to be more prevalent in patients with psychiatric disorders. Therefore, we conducted this review about the impact of tobacco use on co-occurring psychiatric disorders. Various facets of this interaction between tobacco use among those with co-occurring psychiatric disorders have been explored. It has been found that people with psychiatric disorders have a higher chance of currently smoking tobacco and lesser chance of cessation. Tobacco use and mental disorders continue to share a complex relationship that has been further evolving after the change in the pattern of tobacco use and also the advent of newer modalities of treatment. However, at the same time, it is believed that cessation of smoking may lead to improvement in the symptoms of mental illness.

Excessive use of alcohol has been identified as a major contributor to the global burden of disease. Excessive use of alcohol is a component cause of more than 200 disease and injury conditions. Alcohol use has been associated with increased morbidity and mortality across all regions of the world including South-East Asia. Epidemiological as well as clinic-based studies from Western countries have reported a high prevalence of co-occurrence of alcohol use disorder and psychiatric disorders. The research has established the clinical relevance of this comorbidity as it is often associated with poor treatment outcome, severe illness course, and high service utilization. Understandably, dual disorders in from of alcohol use disorders and psychiatric disorders present diagnostic and management challenge. The current article is aimed to review systematically the published Indian literature on comorbid alcohol use disorders and psychiatric disorders.

Context: Retention in treatment can improve the outcomes of patients with substance use disorders., Aims: This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders., Setting and Design: This record-based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in Northern India., Materials and Methods: Patients were classified as being retained in treatment or drop-outs based on follow-up records., Statistical Analysis: Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment., Results: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10(th) grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance-related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention., Conclusion: Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.

Background & Objectives: There has been a limited focus on prescription drug abuse among women in the country. Choice of psychoactive substance, reasons for initiation and co-occurring disorders have been found to be different among men and women. The current study was aimed at studying the profile of female patients seeking in-patient treatment for prescription drug use over a period of five years at a tertiary care drug dependence treatment centre in India., Methods: Case records of all female patients admitted with substance use disorder at a national level drug dependence treatment centre in north India across five years (between January 2008 and December 2012) were reviewed retrospectively to study their socio-demographic and clinical profile. The information was gathered using a semi-structured proforma and detailed case records. Abstinence, relapse and retention rates were calculated., Results: Over the five years, 31 female patients were admitted with prescription drug abuse. Of them, 12 (39%) used prescription opioids and 11 (36%) used prescription opioid along with benzodiazepines. Commonest prescription opioid was pentazocine used by 87 per cent of the women. Twenty two (71%) women were introduced to opioid by medical practitioners and commonest reason for introduction was pain (among 48%). Common co-occurring psychiatric diagnoses were depressive disorder (26%), cluster B traits/disorder (19%) and somatoform disorder (13%). Eight women did not complete treatment and left against medical advice. Thirteen women were advised maintenance treatment, and 70 per cent of them were retained for at least six months., Interpretation & Conclusions: Our findings revealed a link between mental illness, pain and non-medical use of prescription opioids among women. Majority of these women received opioids as a legitimate prescription form physician. Therefore, these legitimate prescribers should be trained for pain management to facilitate proper treatment of pain and to prevent the subsequent misuse of these medicines. Female patients with frequent pain complaints should be assessed for psychopathology while prescribing opioids.

Objective: The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students., Methods: The questionnaire included a sociodemographic profile of participants and Young's Internet Addiction Test., Results: The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Being male and spending more time on the internet were correlated with problematic internet use. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities., Conclusions: It is important to address problematic internet use among medical students. The correlates can help identify those at increased risk.

Diabetes and psychiatric disorders share a bi-directional relationship, with both affecting each other adversely. Just as achieving glycaemic control is important, so is ensuring that the person enjoys a good quality of life. All individuals with diabetes must be screened regularly for co-morbidity, especially depressive and anxiety disorders. Multiple evidence based psychotropic pharmacological interventions are available for management of these psychiatric disorders. Additionally, non-pharmacological interventions play a key role in comprehensive management of such patients.

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.

Aims: This study evaluated the measurement invariance of the strengths and difficulties questionnaire (SDQ) self-report among adolescents from seven different nations., Methods: Data for 2367 adolescents, aged 13-18 years, from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria and Croatia were available for a series of factor analyses., Results: The five-factor model including original SDQ scales emotional symptoms, conduct problems, hyperactivity-inattention problems, peer problems and prosocial behaviour generated inadequate fit degree in all countries. A bifactor model with three factors (i.e., externalising, internalising and prosocial) and one general problem factor yielded adequate degree of fit in India, Nigeria, Turkey and Croatia. The prosocial behaviour, emotional symptoms and conduct problems factor were found to be common for all nations. However, originally proposed items loaded saliently on other factors besides the proposed ones or only some of them corresponded to proposed factors in all seven countries., Conclusions: Due to the lack of a common acceptable model across all countries, namely the same numbers of factors (i.e., dimensional invariance), it was not possible to perform the metric and scalar invariance test, what indicates that the SDQ self-report models tested lack appropriate measurement invariance across adolescents from these seven nations and it needs to be revised for cross-country comparisons.

Background and Aims: Patients with diabetes mellitus frequently experience erectile dysfunction. This systematic review and meta-analysis were conducted to find efficacy and tolerability of phosphodiesterase 5 (PDE5) inhibitors in patients with diabetes mellitus experiencing erectile dysfunction., Methodology: Electronic searches were carried out to identify English language peer-reviewed randomized controlled trials (RCTs), which reported clinical efficacy of any PDE5 inhibitor in patients with diabetes mellitus having erectile dysfunction. Effect sizes were computed using Cohen's d, and I(2) -test was used to assess heterogeneity. Pooled mean effect sizes were computed using random-effects model. Number needed to treat (NNT), and the adverse event rates were computed., Results: The systematic review included a total of 17 studies yielding 25 comparisons. Three studies were open RCTs while others were double-blind RCTs. The pooled mean effect size of any PDE5 inhibitor over placebo was 0.926 (95% confidence intervals [CI]: 0.864-0.987; I(2) =26.3). The pooled mean effect size for sildenafil was 1.198 (CI: 1.039-1.357; I(2) =0), for tadalafil was 0.910 (CI: 0.838-0.981; I(2) =33.6), and for vardenafil was 0.678 (CI: 0.627-0.729; I(2) =0). In pooled analysis, the NNT for sildenafil, tadalafil, vardenafil and any PDE5 inhibitor was 2.4, 2.6, 4.1 and 3.0 respectively. The most common side effects were headache, flushing, and nasal congestion., Conclusions: PDE5 inhibitors are effective and safe medications for the treatment of sexual dysfunction in patients with diabetes mellitus experiencing erectile dysfunction.

As injectable therapies such as human insulin, insulin analogs, and glucagon-like peptide-1 receptor agonists are used to manage diabetes, correct injection technique is vital for the achievement of glycemic control. The forum for injection technique India acknowledged this need for the first time in India and worked to develop evidence-based recommendations on insulin injection technique, to assist healthcare practitioners in their clinical practice.

Background: The Death Adjustment Hypothesis (DAH) postulates two key themes. Its first part postulates that death should not be considered the end of existence and the second part emphasizes that the belief in immortal pattern of human existence can only be adopted in a morally rich life with the attitude towards morality and materialism balanced mutually. We wanted to explore Death Adjustment in the Indian subcontinent and the differences among, Indians, Pakistanis and Bangladeshis. We also wanted to find the relationship between death adjustment (i.e., adaptation to death), materialistic thoughts and death adjustment thoughts., Methods: This was a cross-sectional study, conducted from May 2010 to June 2013. Using a purposive sampling strategy, a sample of 296 participants from the Indian subcontinent [Pakistan (n=100), Bangladesh (n=98) and India (n=98)] was selected. Multidimensional Fear of Death Scale (MFODS) was used to measure death adjustment. The rest of the variables were measured using lists of respective thoughts, described in elaborated DAH. Analyses were carried out using SPSSv13., Results: The mean death adjustment score for Pakistani, Indian and Bangaldeshi population were 115.26 +/- 26.4, 125.87 +/- 24.3 and 114.91 +/- 21.2, respectively. Death adjustment was better with older age (r=0.20) and with lower scores on materialistic thoughts (r = -0.26). However, this was a weak relation. The three nationalities were compared with each other by using Analysis of variance. Death adjustment thoughts and death adjustment were significantly different when Indians were compared with Bangladeshis (p=0.00) and Pakistanis (p=0.006) but comparison between Bangladeshis and Pakistanis showed no significant difference., Conclusions: Subjects with lesser materialistic thoughts showed better death adjustment. There are differences between Muslims and non-Muslims in adjusting to death.