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Background & objectives: The patterns of abused psychoactive substances change over time, and it is important to document such changes. The present retrospective study was carried out to document these changes in patients registered in a de-addiction centre in north India over three decades. Methods: Case notes of all patients registered in the centre from September 1978 till December 31, 2008 were reviewed. Comparisons were made among three decades (1978-1988, 1989-1998, and 1999-2008). Results: The number of registered subjects increased eight-fold over the decades, and age of the subjects presenting for the treatment decreased. The percentages of subjects presenting for the treatment with opioid dependence were 36.8 per cent (n=204), 42.9 per cent (n=809) and 53.2 per cent (n=2219), respectively for the three decades (P

Background & objectives: The research on the association of metabolic syndrome (MS) and substance abuse is scanty. The present research aimed to study the prevalence and correlates of MS among the inpatients at a Drug De-addiction Centre in north India. Methods: Consecutive male subjects (N=110) admitted to a drug de-addiction centre during July to December 2009 with a primary diagnosis of alcohol or opioid dependence were evaluated for the presence of MS as per the International Diabetes Federation (IDF) criteria. Results: The prevalence of MS was 24.6 and 29.3 per cent in alcohol and opioid dependent groups, respectively. MS showed a significant association with the age and body mass index (BMI) in the opioid dependent group. Co-morbid tobacco use was not associated with MS in either group. Interpretation & conclusions: The prevalence of MS in our sample of alcohol and opioid dependent male inpatients was greater than the prevalence of MS in general population, however it was comparable to that reported in physical and other psychiatric disorder populations. Even though the absence of any comparative study limits the generalizability of our findings, results indicate towards a need for screening of the patients with substance dependence especially for those aged above 30 years and/or having a high BMI for MS.

Substance use disorders have undergone major changes in both the international (ICD-10) and American (DSM-IV) nosological systems, thus necessitating a study of cross-system agreement between ICD-10 and DSM-IV substance dependence, especially from a developing country setting. Further, endorsement rates for various substance dependence criteria in the two systems need to be studied from a similar perspective. Hence, 221 consecutive patients with 279 diagnostic categories of substance dependence attending a de-addiction centre in Northern India were studied with regard to endorsement of the various ICD-10 and DSM-IV criteria as well as for cross-system agreement for severity of dependence. High endorsement rates were seen for most criteria in both the systems, except for those related to 'persistence despite harm' and 'salience (neglect of various activities, plus excessive time spent to procure the substance)'. There were some significant differences, however, between endorsement rates across different substance categories in both the systems. Cross-system agreement on severity of substance dependence ranged from fair to good for all categories combined, and was good to excellent for the opioid category. The category of 'others' (nicotine, cannabis and sedative-hypnotics) showed poor cross-system agreement Overall, the results lend support to the basic theoretical construct behind both ICD-10 and DSM-IV substance dependence syndrome from a developing country perspective.

Introduction of potent antipsychotics for the treatment of schizophrenia not only brought changes in the outlook for management of this disorder but also infused optimism and hope. However, substantial number of patients fail to respond to conventional antipsychotics thus creating a class of patients who are termed as treatment resistant, treatment refractory or difficult to treat patients. This update focuses on such patients and provides description of various options for their management Though atypical antipsychotics offer respite to a vast number of such difficult to treat patients, their efficacy is perhaps over-emphasised. Conversely, the potential of psychosocial therapies in such patients has not been fully exploited. Management of such patients in the community is a challenge and in taking up this gauntlet, a judicious mix of pharmacotherapy and psychosocial intervention strategies, close monitoring of the patients with a view to detect prodromes of relapse and early intervention are likely to play increasingly important part.

Aim To study the profile of psychiatric disorders in medical-surgical inpatients so that subpopulations with particular mental health care needs could be identified. Findings: a retrospective analysis of 1245 referrals seen over seven years showed that psychiatric profiles in referrals from different sub-populations divided according to age, gender, source of referral and medical-surgical diagnosis, were quite dissimilar. It was felt that non-recognition of specific needs of these client groups had led to low referral rates (0.65%), and to referral practices wherein the needs of the consultee (referral for disturbed behaviour) and the consultant (management by pharmacologic agents) and certain social biases (low referrals for suicide attempts) had taken precedence over the requirements of optimal management of the cases. Implications : Financial and manpower constraints limit the advocacy for a superspecialist orientation, as a policy in India. It is recommended that while continuing with the provision of general consultation services, psychiatrists should acquire expertise in areas of C-L work, which fit in with their area of interest in general psychiatry.