Neurocognitive Functions in Patients with Comorbid Hepatitis C and Opioid Dependence: A Comparative Study.

Background: Hepatitis C virus (HCV) infection is commonly comorbid with opioid dependence (OD). We wanted to compare the neurocognitive functions of OD subjects with or without HCV [HCV (+), HCV (-)] and healthy controls (HC). Methods: We recruited 40 adult subjects (age 18-55 years) in each group. HCV(+) group had a detectable viral load. Subjects with HIV or hepatitis B infection, head injury, epilepsy, or comorbid mental illness were excluded. We administered Standard Progressive Matrices (SPM), Wisconsin Card Sorting Test, Iowa Gambling Task (IGT), trail-making tests A and B, and verbal and visual N-back tests (NBT) one week after opioid abstinence. The group differences in cognitive performance were adjusted for age and years of education. Effect size (ES) is expressed as Cohen's D. Results: The HCV(+) and HCV(-) groups did not differ in potential effect modifiers (age and years of education) or confounders (age of opioid initiation, duration of use, dependence severity, tobacco use, and cannabis use) of neuropsychological functioning. HCV(+) showed significantly poorer performance than HCV(-) in SPM (P = 0.006; ES = 0.72). Both HCV(+) and HCV(-) performed worse than controls in IGT(P < 0.001; ES = 0.8) and visual NBT[P < 0.01 and ES > 1 for total errors]; HCV(+) had a larger ES of group difference than HCV(-). HCV(+) had higher error scores in verbal NBT than control. Conclusion: HCV(+) has poorer general intellectual ability and reasoning than HCV(-) persons and controls. Chronic HCV infection causes a higher magnitude of dysfunction in decision-making and visual working memory in opioid-dependent individuals.

Quality of Life, Social Support, Coping Strategies, and Psychiatric Morbidity in Patients with Rheumatoid Arthritis.

Background and Objectives Patients with rheumatoid arthritis (RA) have greater psychological morbidity, despite that research in this area is scarce from developing countries. This study was aimed to assess the association of quality of life, social support, coping strategies, and psychological morbidity in patients with RA. Materials and Methods In this cross-sectional study, 40 patients with RA, who were not receiving steroids or disease modifying antirheumatic drugs, were recruited through purposive sampling. Social support questionnaire, coping strategy check list, and World Health Organization quality of life-BREF (WHOQOL-BREF) were administered to assess social support, coping, and quality of life, respectively. Results More than half of the patients had psychiatric disorders (60%), with depression being the commonest disorder (52.5%). Internalization coping and disease severity indicators like tender joints counts, swollen joints counts, pain, and disease activity were found as significant predictors for psychiatric disorders, while externalization coping, quality of life (all domains), and physical functions were found to protect against psychiatric morbidity. Conclusions Coping, quality of life, disease severity, and physical functions predicted the psychiatric disorders in RA. Multipronged interventions to enhance quality of life with promoting adaptive coping and timely treatment may further improve their mental health and overall disease course.

A Scoping Review of the Prevalence and Correlates of Sexual Dysfunction in Adults With Substance use Disorders.

BACKGROUND: Substance use may affect sexual functioning in both men and women. Comorbid sexual dysfunction adds to the clinical burden of substance use disorders (SUD). AIMS: The broad aims were to identify research conduct, types of the available evidence, and research gaps in (i) estimating the incidence, prevalence, type, and severity of sexual dysfunction in adults with SUD; (ii) exploring correlates of sexual dysfunction in SUD. METHODS: We conducted systematic searches on PubMed, Google Scholar, and Embase for studies published in the English language between August 1954 and November 2020. We included prospective and cross-sectional observational studies that had examined the prevalence or incidence of any sexual dysfunction in adults of either gender with substance use disorders. Review articles and those with an exclusive focus on tobacco use disorders were excluded. The review was registered in PROSPERO. RESULTS: Our search identified 65 relevant articles, including five prospective studies. All the prospective studies and most of the cross-sectional studies (n = 40) were done among men and subjects with alcohol (n = 20) and opioid (n = 23) use disorders in clinical populations. Substance use and sexual dysfunction were assessed by a wide range of instruments. Prospective studies reported a prevalence of sexual dysfunction at 75% and 61% for alcohol and opioid use disorders, respectively. The prevalence of any sexual dysfunction in cross-sectional studies ranged between 15 and 100 percent. Erectile dysfunction was the most commonly studied and observed sexual dysfunction. Comorbidity and socioeconomic deprivation were consistently associated with a higher occurrence of sexual dysfunctions. STRENGTHS: We did not limit our review by the type of substances and year of publication. We adhered to the standards of conducting and reporting scoping reviews; hence, our review results should be replicable, transparent, and reliable. LIMITATIONS: The wide clinical and methodological heterogeneity precluded a systematic review. CONCLUSION: Research gaps exist in women, non-clinical population, stimulants, and cannabis use disorders, and effect of treatment of SUD in sexual functioning. The quality of evidence is poor. Ghosh A, Kathiravan S, Sharma K, Mattoo SK. A Scoping Review of the Prevalence and Correlates of Sexual Dysfunction in Adults With Substance use Disorders. J Sex Med 2022;19:216-233.

Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India.

BACKGROUND: Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. AIM: To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. MATERIALS AND METHODS: A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention - 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital - baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. RESULTS AND CONCLUSIONS: Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.

Age of onset of substance use in patients with dual diagnosis and its association with clinical characteristics, risk behaviors, course, and outcome: A retrospective study.

RESEARCH QUESTION: Do patients with dual diagnosis (DD) with an early initiation of substance use and subsequent early onset substance use disorder (EOS) differ from those with late onset substance use disorder (LOS) regarding characteristics, sex-related risk behaviors, course, and outcome? OBJECTIVES: The aim is to study EOS and LOS groups of patients with DD attending a treatment center with regard to clinical characteristics, type of psychiatric disorders, risk behaviors, and short-term outcome. MATERIALS AND METHODS: Retrospective chart review of patients diagnosed with DD (n = 307) with regard to the above variables. Diagnoses of both substance use disorders (SUDs) and psychiatric disorders were made by qualified psychiatrists as per the International Classification of Diseases, 10th revision. RESULTS: Among 307 participants with DD, 100 were in EOS group (onset of SUD before 18 years of age as assessed clinically) and 207 in LOS group. Cannabis as the primary substance was more prevalent in the EOS (30%) than that of the LOS group (12%). Psychotic disorders were more prevalent in the EOS group (41%) followed by mood disorders (30%), while the reverse was true in the LOS group (27.5% and 56.5%, respectively). When compared to the LOS group, the EOS group had higher number of psychiatric admissions, reported higher prevalence of risky sexual behaviors (unprotected sexual intercourse, multiple sexual partners, and history of sexual intercourse with commercial sex workers), showed poorer treatment adherence, and worse outcome regarding both psychiatric disorder and SUD (all differences significant at P < 0.05). CONCLUSIONS: DD patients differ significantly based on the age of onset of substance use. These may have therapeutic and management implications.

Brief intervention in substance use disorders.

Unhealthy substance use lies on a wide range that extends from occasional mild risky/harmful/hazardous use to severe substance use disorder. Brief intervention (BI) is a technique, used to initiate change for an unhealthy or risky substance use. It can be delivered by a vast array of trained professionals, in opportunistic settings (i.e. in people seeking help not for their substance use, but either its consequences or for completely unrelated physical or psychiatric disorders), and across substances, age and ethno-cultural groups. The six common elements of BIs are summarized by the acronym FRAMES, consisting of Feedback, Responsibility, Advise, Menu for change, Empathy, and enhancing Self-efficacy. BI has also been strategically combined with referral to appropriate treatment services. BI has shown efficacy for reducing substance use and its harmful consequences. The evidence for post-BI improved functionality and quality of life are also emerging.

Initial treatment dropout in patients with substance use disorders attending a tertiary care de-addiction centre in north India.

BACKGROUND & OBJECTIVES: Dropout from substance use disorders treatment is associated with poor outcomes. Although many factors have been associated with an early dropout of patients, the reasons for dropping out of treatment prematurely remain poorly understood particularly in the Indian context. This study was aimed to study socio-demographic and clinical variables predicting initial dropout of patients attending a tertiary care de-addiction treatment centre in north India. METHODS: Information was extracted from the records of consecutive newly registered patients from January 2011 to December 2014. The patients who did not come for follow up within 30 days of the first contact were defined as initial dropouts. RESULTS: Data of 7991 patients could be retrieved. Majority of the sample consisted of male, married and employed individuals. Of them, 4907 patients (61.3%) were considered initial dropouts. Multivariate analysis revealed that after controlling for other factors, greater age, being employed, lower educational status, lesser duration of substance use, use of alcohol, opiate, tobacco, cannabis or sedative-hypnotic use but the absence of multi-substance use predicted initial drop out. INTERPRETATION & CONCLUSIONS: This study identified some socio-demographic and clinical variables which might predict treatment attrition in substance use disorders. Clinician's awareness towards these factors and tailor-made intervention might improve initial treatment retention. Future research could be directed to find the validity of this assumption.

Organ transplant & the psychiatrist: An overview.

Organ transplantation has emerged as the saving grace for those who are suffering from end organ disease. Advent of modern surgical procedures and immunosuppressants further decrease morbidity and mortality. Meta-analyses have shown that post-organ transplantation quality of life improves for social, physical and daily activity functioning, but not consistently for psychological health. Psychiatrists can play a useful role not only in selecting the best suitable candidate for the procedure by psychosocial screening but also to tackle post-operation psychological issues that trouble patients as well as caretakers and decrease their quality of life. Issues like selection of patients with psychiatric disorders and substance abuse for transplantation process and their treatment both pre- and post- operation, risky health behaviours, treatment adherence for immunosuppressants and psychological support for caretakers can be better addressed by a psychiatrist who is sensitive towards these issues. Prescribing various psychotropics and immunosuppressants in the background of impaired organ function and drug-drug interaction is further challenging. Thus, psychiatrists need to be knowledgeable about these issues and should be an integral part of organ transplantation team for overall better outcome.

Cardiovascular risk factors among bipolar disorder patients admitted to an inpatient unit of a tertiary care hospital in India.

OBJECTIVE: The study aimed to examine the prevalence of cardiovascular risk factors in patients with bipolar disorder. METHODS: By consecutive sampling, 93 inpatients (aged ≥20 years) diagnosed with bipolar disorder were evaluated for 10 year coronary heart disease (CHD) risk and 10-year cardiovascular mortality risk (CMR) on the Framingham (10-year all CHD events) function/risk equation and Systematic Coronary Risk Evaluation (SCORE) respectively. RESULTS: Ten-year CHD risk was 3.36% and 10-year CMR was estimated to be 1.73%. One tenth (10.7%) of the sample was found to have very high/high CHD risk (≥10) and 6.45% of the sample had high CMR risk (≥5). More than half (54.88%) of patients had metabolic syndrome. Compared to females, males had higher Framingham function score (4.09±5.75 vs 1.59±1.05, U value - 634.5*, p<0.05) and had higher very high/high CHD risk (≥10) (15.1% vs 0, χ(2) 4.58, p<0.05). CONCLUSIONS: Findings of the present study suggest the presence of cardiovascular risk factors and higher rate of metabolic syndrome in patients with bipolar disorder. Considering this fact, there is an urgent need for routine screening for cardiovascular risk factors in these patients. Mental health professionals should be aware of these risks; there is need to develop preventive strategies to reduce the cardiovascular risk in this population.

Profile of inhalant users seeking treatment at a de-addiction centre in north India.

BACKGROUND & OBJECTIVES: Inhalants are substances whose chemical vapors are inhaled to produce euphoric, disinhibiting, and exciting effects. Data on inhalant abuse in India are relatively scarce. We report the demographic and clinical profile of inhalant users among the treatment seekers at a Drug De-addiction and Treatment Centre in north India. METHODS: The records of treatment seekers at the Drug De-addiction and Treatment Centre, over 10 years (2002-2011) were scanned to identify 92 cases reporting inhalant use. Of these 92 cases, the complete record files were available for 87 (94.6%) cases. These case files were reviewed and the relevant data were collected and analyzed. RESULTS: Over the study period of 10 years, the number of cases with inhalant abuse per year rose steadily to peak at 20 cases (4.08% of new cases) in 2006 and then stabilized at 1-3 per cent of new cases annually. Of the 87 cases studied, all were males with a mean age of 18.9±4.12 yr, mean education of 9.8±3.42 yr and mean family income of Rs. 7676±7343.15 (median: Rs. 5000). Majority of subjects were unmarried (89.7%), urban resident (79.3%), and from a nuclear family (78.2%). About half of the subjects were students (50.6%). The most common inhalant used was typewriter correction fluid (73.6%) followed by typewriter diluent fluid (19.5%) and glue (6.9%). The most common reason for initiation was curiosity. The mean age of onset of inhalant use was 16.3±4.22 yr. Most subjects fulfilled the criteria for inhalant dependence (85.1%). Psychiatric co-morbidity and the family history of substance dependence were present in 26.4 and 32.9 per cent subjects, respectively. Majority of the subjects reported drug related problems, occupation and finance being the worst affected. Interpretations & conclusions: Our results showed that the inhalant users were mostly urban youth belonging to middle socio-economic class families. The principal sources of inhalant abuse were the commonly available substances like typewriter correction fluids and majority of the subjects initiated it out of curiosity. Nearly three-fourth of the subjects used some other substance of abuse in addition, tobacco being the most common. In view of associated drug related problems, there is a need for strategies to prevent this emerging health care problem.

Delirium: Predictors of delay in referral to consultation liaison psychiatry services.

OBJECTIVE: To evaluate the predictors of delay in psychiatry referral for patients with delirium. MATERIALS AND METHODS: The consultation liaison psychiatry registry and case notes of 461 patients referred to psychiatry consultation liaison services and diagnosed as having delirium were reviewed. Data pertaining to sociodemographic variables, clinical variables, Delirium Rating Scale-Revised 98 version, etiologies associated with delirium were extracted. RESULTS: Older age, presence of and higher severity of sleep disturbance, presence of and higher severity of motor retardation, presence of visuospatial disturbances, presence of fluctuation of symptoms, being admitted to medical ward/medical intensive care units, and absence of comorbid axis-1 psychiatry diagnoses were associated with longer duration of psychiatric referral after the onset of delirium. Of these only four variables (presence of sleep disturbance, presence of motor retardation, being admitted to medical ward intensive care units and absence of comorbid axis-1 psychiatry diagnoses) were associated with longer duration of psychiatric referral in the regression analysis. CONCLUSION: The variables associated with delay in psychiatry referral for delirium suggest that there is a need to improve the understanding of the physicians and surgeons about the signs and symptoms, risk factors, and prognostic factors of delirium.

Cardiac risk factors and metabolic syndrome in patients with schizophrenia admitted to a general hospital psychiatric unit.

OBJECTIVE: The study aimed to evaluate the prevalence of cardiovascular risk (CVR) factors and metabolic syndrome (MS) in patients with schizophrenia. MATERIALS AND METHODS: By consecutive sampling, 143 patients (of age ≥ 20 years), out of total 159 patients with schizophrenia admitted to the inpatient unit were evaluated for the coronary heart disease (CHD) risk as per Framingham (10-year all CHD events) function/risk equation and systematic coronary risk evaluation (SCORE) - 10-year cardiovascular mortality risk (CMR). Prevalence of MS was estimated by using the consensus definition. RESULTS: Fifty-two (36.4%) patients fulfilled the criteria for MS. 10-year CHD risk was 1.65%, and 10-year CMR was 1.39%. Compared to females, males had higher Framingham score (1.96 ± 2.74 vs. 1.09 ± 0.41, U value 1987.5*, P < 0.05). CONCLUSION: Patients of schizophrenia have a high prevalence of MS and CVR factors. Hence, there is a need to screen the patient of schizophrenia for the same and manage the same as early as possible during the course of illness.

Comparative study of prevalence of metabolic syndrome in bipolar disorder and schizophrenia from North India.

BACKGROUND: Very few studies have compared the prevalence of metabolic syndrome (MS) between patients with bipolar disorder and schizophrenia. AIM: The study aimed to compare the prevalence of MS in patients with bipolar disorder and schizophrenia. MATERIALS AND METHODS: By consecutive sampling, 126 patients with schizophrenia and 72 patients with bipolar disorder admitted to a psychiatry inpatient unit were evaluated for the presence of MS using the criteria of International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III). A control group of 50 healthy subjects was used to represent the general prevalence of MS in the community. RESULTS: In the bipolar disorders group, 40 patients (55.55%) fulfilled IDF criteria and 45 (62.5%) satisfied modified NCEP ATP-III criteria for MS. These figures were significantly higher than those for the schizophrenia group (34.1% IDF and 36.5% modified NCEP ATP-III criteria). Prevalence of MS was 6% in the healthy control group and significantly less than both schizophrenia and bipolar disorder group. CONCLUSION: In the sample studied, prevalence of MS is significantly higher in bipolar disorder compared with schizophrenia. The prevalence of MS in both the clinical groups was significantly higher than the healthy control group.

Metabolic syndrome in alcohol-dependent men: a cross-sectional study.

BACKGROUND: In the context to mental illness metabolic syndrome (MS) has gained significant attention in the last decade. The present research aimed to study the prevalence of MS and its correlates among the alcohol-dependent men at a deaddiction center in Northern India. MATERIALS AND METHODS: A cross-sectional analysis was done for consecutive male subjects who met the diagnosis of alcohol-dependence syndrome currently using alcohol according to the International Clinical Diagnostic criteria- tenth revision mental and behavioral disorder- Clinical description and diagnostic guidelines criteria (ICD-10). The subjects were evaluated for alcohol consumption and the components of MS as per the International Diabetic Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III). RESULTS: A total of 200 male subjects were studied: 100 subjects meeting ICD-10 criteria for alcohol dependence currently using alcohol; 50 each of genetically related controls and nongenetically related healthy controls. As per the IDF (with ethnicity specific modifications for waist circumference) and NCEP ATP- III definitions, respectively, MS was found to be less prevalent in alcohol-dependent subjects (27% and 18%) in comparison the healthy controls (30% and 20%). CONCLUSION: Findings of the study suggest that irrespective of the amount the current alcohol intake is associated with a lower prevalence of MS and a favorable effect on serum high density lipoproteins and waist circumference. However, the cross-sectional nature of our study does not allow any definitive causal inference.

Family burden with substance dependence: a study from India.

BACKGROUND & OBJECTIVES: A substance dependent person in the family affects almost all aspects of family life. This leads to problems, difficulties or adverse events which impact the lives of family members and causes enormous burden on family caregivers. The present study aimed to assess the pattern of burden borne by the family caregivers of men with alcohol and opioid dependence. METHODS: A cross-sectional study was conducted with ICD-10 diagnosed substance dependence subjects and their family caregivers attending a de-addiction centre at a multispecialty teaching hospital in north India. Family Burden Interview Schedule was used to assess the pattern of burden borne by the family caregivers of 120 men with alcohol and/or opioid dependence. RESULTS: Compared to opioid and alcohol+opioid dependence groups, more often the alcohol dependence group was older, married, currently working, having a higher income and with the wife as a caregiver. Family burden was moderate or severe in 95-100 per cent cases in all three groups and more for 'disruption of family routine', 'financial burden', 'disruption of family interactions' and 'disruption of family leisure'. Family burden was associated with low income and rural location. It was associated neither with age, education or duration of dependence of the patients, nor with family size, type of caregiver or caregiver's education and occupation. INTERPRETATION & CONCLUSIONS: Almost all (95-100%) caregivers reported a moderate or severe burden, which indicates the gravity of the situation and the need for further work in this area.

Relationship between cognitive and non-cognitive symptoms of delirium.

AIM: To study relationship between the cognitive and the non-cognitive symptoms of delirium. METHODS: Eighty-four patients referred to psychiatry liaison services and met DSM-IVTR criteria of delirium were assessed using the Delirium Rating Scale Revised-1998 (DRSR-98) and Cognitive Test for Delirium (CTD). RESULTS: The mean DRS-R-98 severity score was 17.19 and DRS-R-98 total score was 23.36. The mean total score on CTD was 11.75. The mean scores on CTD were highest for comprehension (3.47) and lowest for vigilance (1.71). Poor attention was associated with significantly higher motor retardation and higher DRS-R-98 severity scores minus the attention scores. There were no significant differences between those with and without poor attention. Higher attention deficits were associated with higher dysfunction on all other domains of cognition on CTD. There was significant correlation between cognitive functions as assessed on CTD and total DRS-R-98 score, DRS-R-98 severity score and DRS-R-98 severity score without the attention item score. However, few correlations emerged between CTD domains and CTD total scores with cognitive symptom total score of DRS-R-98 (items 9-13) and non-cognitive symptom total score of DRS-R-98 (items 1-8). CONCLUSIONS: Our study suggests that in delirium, cognitive deficits are quite prevalent and correlate with overall severity of delirium. Attention deficit is a core symptom of delirium.

Psychiatric morbidity in pemphigus and psoriasis: a comparative study from India.

AIM: This study was designed to examine the prevalence of psychiatric morbidity and its psychosocial and psychopathological correlates in patients with pemphigus in comparison to those with psoriasis. MATERIALS AND METHODS: Patients with pemphigus (n=50), group matched for demography, with those with psoriasis (n=30), and healthy controls (n=30), were subjected to cross-sectional assessment for duration, severity, and impact of dermatological disorder, attitude to appearance, social support, coping strategies, disability, quality of life, and psychiatric morbidity and diagnosis. RESULTS: The pemphigus group recorded the psychiatric morbidity rates at 40% by GHQ-12 and 26% by ICD-10; the ICD-10 diagnoses included adjustment disorder (16%), depressive episode (8%), and acute and transient psychosis (2%). This comorbidity was not very different from that of the psoriasis group at 46.7% by GHQ-12 and 36.7% by ICD-10; the ICD-10 diagnoses including adjustment disorder (13.3%), depressive episode (10.0%), alcohol dependence (6.6%), paranoid schizophrenia (3.3%), and delusional disorder plus severe depressive episode with psychotic symptoms (3.3%). The pemphigus group scored higher on disability, despite the dermatological severity and psychosocial profile being similar. Dermatological severity, psychopathology, and certain psychosocial variables were correlated in the pemphigus group, as also in the psoriasis group. CONCLUSIONS: The high psychiatric and psychosocial morbidity in pemphigus and other chronic and severe dermatologic disorders indicates a need for more studies on the psychosocial aspect of these disorders and for sensitization by the dealing physicians with this aspect.

Seroprevalence of anti-hepatitis C virus (anti-HCV) antibody and HCV-related risk in injecting drug users in northern India: comparison with non-injecting drug users.

AIM: The current study was designed to study seroprevalence of anti-hepatitis C virus (anti-HCV) antibody in injecting drug users (IDUs) and non-injecting drug users (non-IDUs) with or without other HCV-related risk behaviour. MATERIALS AND METHODS: Serum of male inpatients of the three groups in a tertiary-care hospital in north India was screened for anti-HCV antibody by enzyme-linked immunosorbent assay (ELISA) for two years. The presence of risk behaviours or risk exposure (sharing needle or other drug-related paraphernalia, multiple sex partners, unprotected sex with commercial sex workers/strangers, and blood transfusion) was assessed with the risk questionnaire. RESULTS: One-hundred and three IDUs (n=103), non-IDUs with other HCV-related risk (n=124) and non-IDUs without other HCV-related risk (n=245) were screened (mean age 31.2 (SD=7.92), 32.6 (SD=9.98) and 36.9 (SD=10.63) years, respectively). Almost 46% of the IDUs, 8.1% among the non-IDUs with HCV-related risk and 3.7% among the non-IDUs without HCV-related risk were seropositive for anti-HCV antibody (p<0.001). A majority of the IDUs have been actively using the drugs (76.7%) for a mean duration of 60.9months (SD=57.05) and a majority used injection buprenorphine in combination with promethazine and/or diazepam (70.9%). Other HCV-related risk behaviours were significantly more common among non-IDUs with other HCV-related risk behaviour. CONCLUSION: Seroprevalence of anti-HCV antibody is high in IDUs compared to non-IDUs, and it is primarily related to injecting risk behaviour.

Carisoprodol: an underrecognized drug of abuse in north India.

BACKGROUND: There is limited literature on clinical profile of subjects abusing carisoprodol. METHODS: Our series of 34 subjects shows that a typical subject was an unmarried, unemployed, urban resident from a nuclear family set up; was a substance abuser before being introduced to carisoprodol by another substance abuser; initiated the use to get a better "kick" and after regular use reported craving and withdrawal symptoms. RESULTS: The effect of carisoprodol was dose dependent: a majority reported a feeling of general wellbeing on consuming up to three tablets; a hypomanic state with 4-10 tablets and confusion, disorientation and drowsiness with >10 tablets at a time. CONCLUSION: Thus being an underrecognized drug of abuse, carisoprodol is in need of wider awareness and regulatory measures to prevent its emergence as a greater menace in the future.