Indian Journal of Psychological Medicine

Drug use is a major public health issue in India. Significant changes in the approach toward drug use have happened in the last few decades. Despite this, no systematic attempt has been made to document the same in the scientific literature. This narrative review attempts to discuss the major drug laws, policies, and national programs of the Government of India (GoI).

A thorough search was conducted to look for policies, programs, acts, and notifications related to substance use/drug use on various websites of different ministries of the GoI. Acts, programs, and policies addressing substance use were identified.

Various drug laws, programs, and acts from the GoI provide a multipronged approach to curbing the procurement of drug use along with its prevention and cure. The Ministry of Social Justice and Empowerment (MoSJE) is the nodal ministry for drug demand reduction. The enactment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act 1985 and Policy 2012 and the implementation of India’s Drug De-Addiction Program (DDAP) are important landmarks in this journey.

The GoI initiatives for reducing the mental health burden in this country in general and substance use disorders (SUDs), in particular, are immense. The acts/statutes/laws/notifications are all interlinked. Stakeholders in mental health, public health, and policy-making need to upgrade themselves with the relevant statutes to curb the menace of drug use.

United States Food and Drug Administration (USFDA) recently approved a novel combination of olanzapine-samidorphan (OLZSAM) for managing olanzapine-associated adverse events (weight gain) in adult patients with schizophrenia and bipolar disorder. To opine about the safety and efficacy of OLZSAM, authors performed a systematic review and meta-analysis to convene justifiable evidence.

A thorough literature search was performed through the databases Embase, Cochrane Library, PubMed, and clinicaltrials.gov, from inception to September 2022, with the keywords: ‘olanzapine and samidorphan’ and schizophrenia; and “ALKS3831” and “lybalvi.” Clinical trials published in English that analyzed the efficacy and safety of OLZSAM were included. The significant outcomes included in this study were change from baseline (CFB) in Positive and Negative Syndrome Scale (PANSS) at the end of the study, the proportion of patients with weight gain at the end of the study, the proportion of patients with at least one adverse event, and the incidence of drug discontinuation due to adverse events.

The change in PANSS score at the end of the study was comparable among groups receiving OLZSAM and olanzapine alone: standardized mean difference (SMD) = 0.04; 95% CI = -0.09 to 0.17; p = 0.57. The OLZSAM group reported less incidence of weight gain: risk ratio (RR) = 0.91; 95% CI = 0.62–1.34; p = 0.63, and any adverse event: RR = 0.99; 95% CI = 0.90–1.09; p = 0.81. Drug discontinuation incidence was higher in the OLZSAM group: RR = 1.22; 95% CI = 0.84–1.79; p = 0.30.

The combination OLZSAM showed comparable efficacy to olanzapine alone in schizophrenia patients, with relatively less incidence of weight gain and adverse events; however, the drug discontinuation due to adverse events was more in the OLZSAM group.

Perinatal depression (PND) is often under-treated and under-recognized. It has a negative impact on infant development and mother–child interactions. This study aims to estimate the prevalence of PND during pregnancy and in the postpartum period and the effect of sociodemographic factors, psychosocial stressors, and obstetric and neonatal factors on PND.

166 antenatal mothers attending tertiary center, who completed the 1st-trimester, were evaluated on baseline sociodemographic, psychosocial, obstetric, neonatal, and post neonatal factors by using a semi-structured questionnaire. Periodic prospective assessments were done using Hamilton depression rating scale (HAMD) at the end of the second and third trimesters and first and sixth weeks of the postpartum period.

Prevalence of PND was 21.7%, 32.2%, 35%, 30.4%, and 30.6%, at the end of the first trimester, during second, and third trimesters, and first and sixth week postpartum, respectively. Factors significantly associated with depressive symptoms included history of previous children with illness (P: 0.013, OR—5.16, CI—1.3-19.5) and preterm birth (P: 0.037, OR—3.73, CI—1.1- 13.2) at the time of recruitment; history of abuse (P: 0.044, OR—3.26, CI—1.1-10.8) and marital conflicts (P: 0.003, OR—3.2, CI—1.4-6.9) by the end of second trimester; history of miscarriages (P: 0.012, OR—2.58, CI—1.2-5.4) by the end of third trimester; lower SES (P: 0.001, OR—3.48, CI—1.64-7.37), unsatisfied living conditions (P: 0.004, OR—2.9, CI—1.4-6.04), alcohol use in husband (P: 0.049, OR—2.01, CI—1.1-4.11), history of depressive episodes (P: 0.049, OR—2.09, CI—1.1-4.46), history of high-risk pregnancy (P: 0.008, OR—2.7, CI—1.29-5.64), history of miscarriages (P: 0.049, OR—2.04, CI—1.1-4.2), stressful events in the postpartum period (P: 0.043, OR—2.58, CI—1.01-6.59), IUD (P: 0.002), preterm birth (P: 0.001), congenital malformations (P: 0.001), dissatisfaction with the sex of the child (P: 0.005, OR—3.75, CI—1.42-9.91), poor family support (P: 0.001), and low birth weight (P: 0.001, OR—16.78, CI—6.32-44.53) in the postpartum period. These analyses are purely exploratory.

PND is highly prevalent from the early antenatal period onwards; this warrants periodic assessment of depression among high-risk mothers, using a validated tool, for early diagnosis and management.

Mental Healthcare Act 2017 (MHCA) came into force on 29 May 2018. Goa State Mental Health Authority (GSMHA) notified the Mental Health Review Board on 8 February 2022, completing the important process of implementation of the act. The transition comes with challenges.

A qualitative study was conducted with 18 practicing psychiatrists who had worked under Mental Health Act 1987 as well as MHCA 2017 through purposive sampling across Goa. Data was collected through individual interviews; analysis was done by Braune and Clarke’s framework of Thematic Analysis.

Eighteen psychiatrists participated: 4 private, 3 secondary and 11 from tertiary levels. The themes extracted were work during MHA 1987, transition, and after the implementation of MHCA 2017. Some participants reported difficulties, felt an increase in workload, and had negative emotions, while a few were neutral, indicating mixed perceptions.

This study highlights the administrative struggles and moral dilemmas faced by psychiatrists in handling the new legislation. It’s imperative that the implementation of new act should be carried out with sufficient resource allocation and monitoring mechanisms.

Among the Indian adolescents, the prevalence of psychiatric morbidity and alcohol use disorders (AUD) are 7.3% and 1.3%. However, no separate data are available for indigenous tribal populations. This study estimated the prevalence of psychiatric morbidity and AUD and associated socio-demographic factors among adolescents in the tribal communities in three widely varying states in India.

Using validated Indian versions of the MINI 6.0, MINI Kid 6.0, and ICD-10 criteria, we conducted a cross-sectional survey from January to May 2019 in three Indian sites: Valsad, Gujarat (western India); Nilgiris, Tamil Nadu (south India); and East Khasi Hills district of Meghalaya (north-east India) on 623 indigenous tribal adolescents.

Aggregate prevalence of any psychiatric morbidity was 15.9% (95% CI: 13.1–19.0) (males: 13.6%, 95% CI: 10.0–18.1; females: 17.9%, 95% CI: 13.9–22.6), with site-wise statistically significant differences: Gujarat: 23.8% (95% CI: 18.1–30.2), Meghalaya: 17.1% (95% CI: 12.4–22.7), Tamil Nadu: 6.2% (95% CI: 3.2–10.5). The prevalence of diagnostic groups was mood disorders 6.4% (n = 40), neurotic- and stress-related disorders 9.1% (n = 57), phobic anxiety disorder 6.3% (n = 39), AUD 2.7% (n = 17), behavioral and emotional disorders 2.7% (n = 17), and obsessive-compulsive disorder 2.2% (n = 14). These differed across the sites.

The prevalence of psychiatric morbidity in adolescent tribals is approximately twice the national average. The most common psychiatric morbidities reported are mood (affective) disorders, neurotic- and stress-related disorders, phobic anxiety disorder, AUD, behavioral and emotional disorders, andobsessive-compulsive disorder.

Street children are vulnerable to adverse health and risk behaviors and drug use. Substance use among street children has been well documented in several countries. This study reports sociodemographic and peer, family, and stress-related factors associated with substance use and non-use in a representative sample of street children of Delhi.

This cross-sectional survey was conducted through six NGOs working with street children, using Respondent Driven Sampling, in nine districts of Delhi (n = 766, 7–18 years). The multivariable model was developed by applying binary logistic regression analysis.

The rate of substance use was 49%. Significant association was found between substance use in the past year and increasing age [Odds Ratio: OR (95% Confidence Interval)] [1.22(1.12,1.33)], male sex [4.34 (2.28,8.26)], lacking psychosocial support from family/relatives [3.27(1.84,5.80)], being engaged in earning from illegal sources, [3.04(1.75,5.29)], family use of substance [2.59(1.38,4.89)], presence of substance-using peers [29.86(14.38,62.01)], lack of non-drug-using peers [2.35(1.46,3.79)], and not possessing basic amenities [2.26(1.31,3.93)].

Multiple modifiable factors exist within the family and peer group, including risk and protective factors or a consequence of substance use. Some challenges in the form of difficulty in reaching out to them and poor treatment seeking by those using substances warrant intensification in both primary and secondary prevention initiatives.

Training the old-age home staff is essential in raising geriatric mental health care standards in India. Inadequate knowledge on ageing and psychosocial interventions is a significant issue in old-age homes. Old-age home staff must know how to provide individualized psychosocial care and support for older adults. Hence this study aimed to test the feasibility of the psychosocial care training program for the staff working in old-age homes.

A quasi-experimental research design (pre-post without a control group) was used. Forty-two staff members participated. Mary Starke Harper Aging Knowledge Exam (MSHAKE) and structured checklist to measure the staff’s knowledge on ageing, psychosocial interventions, welfare legislations, schemes, and support services were administered before, immediately after, and two months after the program and the self-efficacy checklist was administered immediately and two months after the program, to examine the efficacy of the program.

Significant improvement was found in the ageing knowledge and the knowledge of psychosocial intervention and psychosocial care. These improvements continued for two months (p < .001). Similarly, their self-efficacy in managing such problems was also sustained across two post-measurements (p = .045).

Face-to-face training programs would enhance the knowledge of the old age home staff. This Psychosocial Care Training module can be used for training old age home staff to address various psychosocial needs, concerns and other psychosocial problems of the residents.

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.

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.

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).

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.

As no scales are currently available to assess the social-emotional reciprocity (SER) between children with autism spectrum disorder (ASD) and their parents, we aimed to develop a questionnaire for this.

Both quantitative and qualitative techniques were used for content validation. All stages of this study used purposive sampling to choose various groups of experts, mental health professionals, and parents of children with ASD to participate in the development, judgment-quantifying, and pretest stages. Data from 30 parents of children with ASD were gathered for the field test.

Thirty items were retained after content validation. The proportion of consensus regarding the comprehensiveness of the entire questionnaire was 1.00. The scale-level content validity index (CVI) by averaging calculation method and universal agreement calculation method were 0.95 and 0.50, respectively. Following the pretest, a total of 23 questions, on a five-point scale, were retained.

Given the significance of SER between children with ASD and their parents, mental health practitioners should use this questionnaire to understand it to maximize the efficacy of any intervention.