Introduction. Relapse rate after opioid detoxification is very high. We studied the possibility that predetoxification patient characteristics might predict relapse at follow-up and thus conducted this 1-year follow-up study to assess the predictors of relapse after inpatient opioid detoxification. Materials and Methods. We conducted this study in our tertiary care institute in India over two-year time period (1 Jan 2014 to 31 Dec 2015). Out of 581 patients admitted, 466 patients were considered for study. Results and Discussion. No significant difference was found between relapsed and nonrelapsed patients regarding sociodemographic profile; however substance abuse pattern and forensic history showed significant differences. Relapsed patients abused greater amount and used injections more commonly, as compared to nonrelapsed group. Longer duration of abuse was also a significant risk factor. Patients with past attempt of opioid detoxification and family history (parental or first degree) of alcohol abuse had decreased possibility of maintaining remission during 1-year follow-up. Relapsed patients were found to abuse their spouse or parents. Conclusion. Our study compared profiles of relapsed and nonrelapsed patients after inpatient detoxification and concluded predictors of relapse during 1-year follow-up period. Early identification of predictors of relapse and hence high risk patients might be helpful in designing more effective and focused treatment plan.

Background: Opioid dependence is a complicated disorder in which multiple factors interact to influence initiation of use, repeated use, addiction, and relapse. Negative emotional states, such as anger, anxiety, depression, frustration, and boredom are also associated with the highest rate of relapse

AIM:The aim of the study is to compare quetiapine with placebo along with oral naltrexone in the treatment of opioid dependent patients. We conducted the study as opioid dependence is steadily increasing in this area and more research is needed to prevent relapse after opioid detoxification. SETTINGS AND DESIGN: It is a double blind placebo controlled , randomized study that was conducted in department of psychiatry, de addiction unit (Sri Guru Ram Das Institute of Medical Sciences & Research, Sri Amritsar) over one year time period. All the patients who were taken in the study had a confirmed diagnosis of opioid dependence as per ICD 10 criteria. MATERIAL AND METHOD: It is a double blind, placebo controlled, randomized study. A total of 217 subjects were admitted over year, out of which 164 were screened as 53 subjects refused to participate. Out of 164 randomization of 152 patient was done and two groups (1&2) were made. . During detoxification, opioids were given to both groups and stopped after 1-2 weeks. Then all patients were started on Naltrexone 50 mg/day. Group 1 (n=73) received naltrexone (50mg/day) plus quetiapine (50-200mg/day), while group 2 (n=79) received naltrexone (50mg/day) plus placebo (multivitamin) for next 26 weeks. Our primary efficacy measures were relapse rate and percent days of abstinence. Two groups were compared with the help of percentage method and independent t test done. RESULTS: Relapse rate in placebo group was almost twice to that of Quetiapine group. In group 1, 24 subjects (32.87%) had relapsed by the end of 6 months as compared to 56 subjects (70.88%) in group 2. Percent days of abstinence in Quetiapine group were significantly higher as compared to placebo group. DISCUSSION: Our study shows significant advantages in using Quetiapine along with Naltrexone to decrease relapse rate and increase percent days of abstinence after inpatient detoxification.

Background: Injecting drug use is common among substance abusers, who frequently refer to rehabilitation centers and are detected positive for viral markers during routine screening. In this study, we evaluated drug abuse patterns and seroprevalence of HIV, hepatitis B surface antigen (HBsAg), and HCV among substance abusers in a specific period. Objectives: The current study aimed to evaluate drug abuse patterns and seroprevalence of HIV, hepatitis B surface antigen (HBsAg), and HCV among substance abusers in a specific period. Patients and Methods: Substance abusers, admitted to our institute for rehabilitation between January 1, 2013 and June 30, 2016 were recruited in this study. All the patients were interviewed for sociodemographic characteristics and substance abuse history according to the predesigned performa. Blood samples were collected for testing HIV, HBsAg, and HCV. Statistics including percentage and mean were measured to assess the variables. The results were compared with a similar study at the same center, performed between July 1, 2009 and December 31, 2012 (duration, 3.5 years) by the same principal author. Results: We studied 1206 patients, among whom 75.87% were married, and the majority were literate. In addition, most participants had a rural background, and farming was their main occupation. In total, 83.74% (n=1010) of the subjects had opioid dependence, 13.10% (n=158) had alcohol dependence, and 3.15% (n=38) were multiple drug abusers or used other substances. Overall, 192 (9.28%) patients were found positive for one or more viral markers. The majority of substance abusers (n=933; 77.36%) were in the age group of 20 -40 years, among whom 258 (27.65%) were injecting drug users. Conclusions: In this study, the majority of cases (92.70%) had HCV, which is a matter of concern, as very little attention has been paid to HCV prevention and treatment, compared to HIV. Although HBV is not so common (0.06%), vaccination awareness can be still beneficial.

Introduction: Duloxetine is an SNRI (selective serotonin norepinephrine reuptake inhibitor) class of drug widely used as an antidepressant. There is no doubt about its potential role in musculoskeletal pain but its indiscriminate use by physicians has probably started showing its dark side. CASE REPORTS: We present 3 case reports with manic symptoms with Duloxetine for condition other than Major Depression. DISCUSSION: While using Duloxetine, risk benefit ratio should be considered as mania may be a less common adverse effect but its seriousness cannot be undermined. CONCLUSION: A cautious approach is needed by physicians while prescribing Duloxetine. KEYWORDS: Duloxetine, mania, drug induced. INTRODUCTION:Duloxetine is an SNRI (selective serotonin norepinephrine reuptake inhibitor) class of drug widely used as an antidepressant. It has also been widely publicized as a pain killer by parent manufacturing and marketing companies, especially in somatic and neuropathic pains. There is no doubt about its potential role in such conditions other than depression but its indiscriminate use by non-psychiatrists has probably started showing its dark side. A pooled data by Dunner et al. (2005) 5 showed that the estimated risk of Duloxetine related manic switching is 0.1% to 0.2% in patients with major depression.However, he also concluded that diagnostic diligence on the part of the investigators was a methodological limitation of the study, which leads us to interpret that the actual risk of manic switching with Duloxetine still remains unknown. According to Viktrup et al. (2004) 9 , Duloxetine does not induce mania or hypomania in women with stress urinary incontinence and without a history of depression. Carta et al. (2006) 2 found a high frequency of manic symptoms in a sample of female patients with fibromyalgia attending a rheumatology outpatient Unit. According to Duloxetine's summary of product characteristics, mania is a rare side effect. However, we present 3 case reports about patients who had been prescribed Duloxetine by physicians for condition other than Major Depression and presented to psychiatry outpatient with manic symptoms.