Disulfiram (DSF) is one of the recommended aids in the management of alcohol dependence. Hypertension may be a clinically significant, dose-dependent, and usually reversible adverse event of DSF therapy. We report 6 month prospective study of normotensive case of comorbid alcohol and tobacco dependence that developed reversible stage-II hypertension within 2-4 weeks of DSF therapy. We suggest that regular monitoring of blood pressure at least fortnightly for 1st 3 months, followed by monthly for next 3 months, and later once in 3 months, may possibly detect “silent” adverse event of DSF – hypertension.

Objective: Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings ( n = 2150). The objective of this article is to give a brief overview of the initiative Methods: CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. Results and conclusion: From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.

Seizure induction by disulfiram (DSF) an adverse effect of therapeutic dosages of DSF is less understood. In our prospective case series of eight subjects with alcohol dependence a temporal, dose-dependent, and reversible epileptogenic potential due to DSF was noted. Mean duration of onset of first seizure was 2.13 ± 1.13 weeks after initiation of DSF therapy (125-500 mg/day) with no other detectable causes of seizures. Presence of alcohol withdrawal seizures (50%), DSF-induced hypertension (HTN) (37.5%), psychosis (12.5%) were noted, that may suggest common neurobiological underpinnings like dopamine-beta-hydroxylase inhibition. Various types of DSF-induced generalized seizures (tonic-clonic, 62.5%; myoclonic and tonic-clonic, 25%; myoclonic, 12.5%) were effectively managed by halving initial DSF dose (37.5%) even after cessation of antiepileptics, or stopping DSF (37.5%). Presence of alcohol withdrawal seizures, DSF-induced HTN/psychosis during DSF therapy may be early risk factors for dose-dependent and reversible adverse effect of DSF therapy — seizure induction, emphasizing caution.

The context of current education is quickly evolving. The traditional design and delivery of interventions for learning are being challenged and outdated to meet the needs of today's learners. Formal education should provide more versatile learning systems to accommodate the varying needs and demands of students. A global change is urgently required to implement a fundamental shift in the learning paradigm for the technologically driven millennial learners. This is a well-known fact, but the challenge is to explore innovative methods to use technology to attain the actual needs and expectations of these learners. With the increasing problem of substance use disorders as a public health problem and scarcity in the availability of resources for providing adequate treatment, we propose to explore the role of digital technology as a training platform in addiction psychiatry. We have reviewed the currently available platforms which are using digital tools for training in addiction psychiatry. We have also shared our experience at NIMHANS in the use of various digital platforms for training medical officers, psychiatry residents and various health professionals in the area of addiction and we feel that it is having promising scope for expansion and upscaling to generate adequate facilities to provide best practices in addiction management to the rural, remote and underserved areas of the country. However, these digital tools should augment traditional teaching methods and cannot replace them.

Disulfiram is an alcohol-deterring agent with few rare serious adverse effects, usually dose-related, reversible, and more frequent with comorbid alcohol and nicotine dependence. We report a prospective follow-up of such a case with reversible peripheral neuropathy and irreversible optic neuropathy.