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Background: Among persons with schizophrenia (PwS), tobacco use is higher in comparison to the general population, contributing to greater morbidity and mortality. Pharmacological interventions combined with psychosocial interventions are effective in tobacco cessation. While the effectiveness of extant psychosocial interventions—when used in isolation—seems limited, developing better combinations of interventions could help treatment providers deliver tobacco cessation services to PwS at different stages of motivation to quit. We aimed to develop a personalized tobacco cessation intervention package (PTCIP) for PwS. Methods: The stage-based intervention package was developed through a systematic review of interventions for tobacco cessation, the authors' clinical experience, and expert validation. The components of the intervention package, developed for PwS visiting the outpatient psychiatric department, were retained, removed, or added based on the content validity ratio (CVR). Results: The final components included brief advice, principles of motivational interviewing, psychoeducation, decisional balance matrix, positive reinforcement, offering various treatment options, personalized feedback using a smoking-risk calculator, and prediction of cardiovascular risk using the WHO package of essential noncommunicable disease (PEN). The delivery of the intervention package was refined based on pilot testing in eight participants. Conclusion: The tailored package was designed to be delivered by a mental health professional as a single comprehensive 40 min to 45 min face-to-face session, integrated with routine follow-up visits, followed by two telephonic conversations in the second and third week of the initial session. The package needs to be tested in a randomized controlled trial for its effectiveness. [ABSTRACT FROM AUTHOR]

Background: Banning smoking in public places has considerably reduced the number of smokers. However, the sale of loose tobacco encourages tobacco use. There is limited data on compliance with section 7(2) of the Cigarettes and Other Tobacco Products Act (COTPA), 2003, concerning the ban on loose tobacco sales in India. The aim of this study is to assess the compliance of section 7(2) of COTPA concerning the ban on loose tobacco sales in four selected cities of Karnataka. Methods: This community-based study used a cross-sectional design. Two neighboring cities, that is, district headquarter from North (Bidar and Vijayapura) and South (Mandya and Chikkamagaluru) Karnataka were considered for the study. A total of 207 vendors and 204 smokers were selected using time-cluster sampling. Data was collected using observation and interview methods. Semi-structured interview schedules were administered to smokers and vendors. Percentages and frequencies were used to describe the data. Results: Most tobacco vendors (92%) and smokers (91%) were unaware of the loose tobacco ban. Most smokers (76%) perceive that buying cigarettes in packets would increase smoking. Most smokers (96%) prefer to buy cigarettes in loose. The sale of loose tobacco was widely prevalent (94%) in the four surveyed cities. Point of sale of loose tobacco includes tea shops (38%), petty shops (31%), pan shops (25%), and bakeries (6%). Conclusion: There is a high degree of noncompliance with Section 7 (2) of COTPA, 2003 regarding ban on selling loose tobacco. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the effectiveness of mental health work carried out by accredited social health activists (ASHAs) on reduction of the "treatment gap" for severe mental disorders (SMD), common mental disorders (CMDs), and substance use disorders (SUDs) in rural communities. Methods: This study is an offshoot of a larger randomized controlled trial designed to comprehensively compare the effectiveness of two methods of training and empowering grassroots-level workers in mental health. Three primary health centers (PHCs) were selected (simple random sampling) as the study group (SG). Thirty-five ASHAs were trained and mentored (National Institute of Mental Health and Neurosciences-Extension of Community Health Outcomes model of skilled capacity building using digital technology) for a period of 18 months in identifying/counseling/referral of commonly prevalent mental health problems in the community. Control group (CG) PHCs' ASHAs (n = 36) received "training as usual" (i.e. 1 day in person classroom training session). Both the groups were regularly contacted by the research team to monitor for progress. Reduction in "treatment gap" was evaluated using pre-post design for SG and CG separately, and the same was compared between SG and CG. Results: A total of 35,023 adults were screened, and positives were identified, counseled, and referred for care and treatment. Treatment gap for SMDs and SUDs reduced significantly both in SG and CG (SMDs: 10% vs. 38%, respectively; P = 0.03 for both; SUDs: 51% vs. 70% respectively; P < 0.001 for both) while it increased for CMDs (13% vs. 14% P < 0.01 and 0.09, respectively). Comparatively speaking, SG fared better for SUDs (P < 0.05), and CG did better for SMDs (P < 0.05). It was unequivocal for CMDs (P = 0.48). Conclusion: ASHAs could be effectively empowered to carry out mental health work resulting in meaningful reduction of treatment gap for the priority mental illnesses including SMD and SUDs. [ABSTRACT FROM AUTHOR]

Substance use patterns are notorious for their ability to change over time. Both licit and illicit substance use cause serious public health problems and evidence for the same is now available in our country. National level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing causes of concern. Preliminary neurobiological research has focused on identifying individuals at high risk for alcohol dependence. Clinical research in the area has focused primarily on alcohol and substance related comorbidity. There is disappointingly little research on pharmacological and psychosocial interventions. Course and outcome studies emphasize the need for better follow-up in this group. While lack of a comprehensive policy has been repeatedly highlighted and various suggestions made to address the range of problems caused by substance use, much remains to be done on the ground to prevent and address these problems. It is anticipated that substance related research publications in the Indian Journal of Psychiatry will increase following the journal having acquired an 'indexed' status. [ABSTRACT FROM AUTHOR]

The number of experts available for the management of alcohol use disorders (AUDs) in rural and underserved areas in India is limited. In this study, a blended training programme was conducted for 26 primary care providers (PCPs) from nine districts of Bihar, in best practices for the management of AUDs. A two weeks on-site training was followed by fortnightly online tele-Extension for Community Healthcare Outcomes (ECHO) clinics for six months using the 'Hub and Spokes' ECHO model, accessible through internet-enabled smartphones. A questionnaire administered at baseline and after six months assessed changes in the PCPs compliance with principles of AUD management. Significant improvements were noted in compliance to principles in the management of AUDs based on self-report. Over the six months period 2695 individuals were screened, of whom 832 (30.8%) had an AUD Identification Test score of more than 16, indicating harmful use or dependence. The PCPs reported retaining 49.1 per cent of the cases for at least one follow up and needed to refer only 80 (3%) cases to specialists for further management. The ECHO model was found to be effective in training PCPs to provide quality healthcare. To confirm these findings, it needs to be tested in a large number of PCPs with a robust study design. [ABSTRACT FROM AUTHOR]

Background: Substance abuse is more prevalent in young adults, putting them at risk for chronic use and early onset of dependence on substances. A well-documented relationship exists between substance use and poor family functioning. Traditional family intervention approaches are time-consuming., Aim: To develop a brief family intervention for parents of young adults with substance use disorder., Methods: A qualitative research design was used. Extensive literature searches and key informant interviews (face to face) with young adults ( n = 5), their parents ( n = 5), and mental health professionals ( n = 5) were conducted. The interviews were audio recorded. A thematic analysis was conducted using Braun and Clarke's six-step approach, and intervention strategies were identified by examining the themes. In addition, experts were consulted to ensure the content validity of the BFI., Results: The BFI program combines psychoeducation and behavioral techniques for parents. BFI involves seven sessions with parents, 45-60 min each, over one week. The BFI sessions consisted of (1) Engagement and Assessment, (2) Healthy Family Functioning, (3) Psychoeducation, (4) Relapse Prevention, (5) Communication Skill Training, (6) Problem-Solving Skill Training, and (7) Parental Monitoring and Supervision., Conclusion: Considering all stakeholders' perspectives, the BFI manual for young adults with substance use disorder has been developed. However, additional research is required to evaluate its feasibility and effectiveness., Competing Interests: Conflicts of interest There are no conflicts of interest.

Background: Rates of smoking in persons with mental illness are reported to be two times higher than those without mental illness in developed countries. We aimed to examine the prevalence and severity of tobacco use, and access to tobacco cessation services among tertiary care psychiatric in-patients in India., Methods: In this cross-sectional study, 500 consecutive adult in-patients in tertiary care with ICD 10 diagnoses, F20-59, were administered a sociodemographic and clinical proforma, Clinical Global Impression-Severity scale, Fagerstrom Test for Nicotine Dependence, Tobacco Craving Questionnaire, Reasons for quitting questionnaire, and Smoke Scale-Adults. Urine cotinine levels were estimated in the last 100 patients. Details of tobacco use and cessation interventions provided were obtained., Results: Overall prevalence of current tobacco use was 34.00%; 34.3%, 32.6%, 43.6%, and 16.7% in patients of F20-29, F30-39, F40-49, and F50-59 categories, respectively. Males used tobacco products at a significantly higher rate (44.85% vs. 17.58% in females) and were highly dependent. Smokeless tobacco use was reported in 20.5% and 18% of female patients with F20-29 and F30-39 diagnoses, respectively. More than half of the tobacco users were not asked about tobacco use and 89.4% of the users were provided no prior assistance for cessation at the time of assessment. Urinary cotinine levels were significantly greater for those who use smokeless forms than smokers or dual users., Conclusions: Nearly a third of psychiatric in-patients are current users of tobacco. Moderate to severe tobacco dependence was observed across psychiatric diagnoses. The assessment and interventions provided were suboptimal., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Psychiatry.)

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