Introduction Post-pandemic alcohol consumption is on the rise due to people starting to adapt themselves to the practice of consuming alcoholic beverages at home. In addition to the direct effects of intoxication and addiction, estimates suggest that alcohol contributes to approximately 20-30% of global cases of oesophagal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle accidents. In India, one-fifth of alcohol consumers were found to be alcohol dependent. The study was done with the primary objective of finding out the prevalence of alcohol dependence among alcohol users and exploring the reasons for alcohol dependence among alcohol users in an urban area of Chengalpattu District, Tamil Nadu. Methodology The study design is an explanatory sequential mixed-methods study. It was done among 624 adult male alcohol consumers in the Chennai district, selected by the cluster sampling method in a community setting. The Alcohol Use Disorders Identification Test (AUDIT) was used to diagnose alcohol dependence. Using the purposive sampling method, in-depth interviews were conducted among 24 alcohol-dependent people to explore and understand their experiences, identify common themes, and provide insights into the problem. Quantitative data were analysed using Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY), and qualitative data were analysed using deductive content analysis using Qualcoder software. Results The mean age of the study participants was 38±7 years. Among current alcohol consumers, 16.9% (106/624) were found to be suffering from alcohol dependence. The significant predictors of alcohol dependence were found to be unskilled occupation (adjusted odds ratio [AOR] = 2.09), having suicidal ideation (AOR = 2.4), alcohol consumption by family members (AOR = 1.90), depression (AOR = 3.98), drinking pattern-affected interpersonal relationships (AOR = 2.29), and not receiving health education about alcohol use in school/college (AOR = 1.74). The major themes and codes identified among alcohol dependents were factors related to mental health, physical health, and social factors. Conclusion This study provides essential points of reference for policymakers and primary care physicians to develop prevention strategies for people to understand and overcome the problem of alcohol addiction, and it also sheds light on the burden of alcohol dependence and their lived experiences.

Recreational use of methamphetamines has greatly increased in frequency across the world. Like other stimulants, methamphetamines can cause several health consequences, and their addictive nature can lead to psychiatric disorders. Suicidal ideation and attempts are common in methamphetamine users and have become a leading cause of death next to incidental overdoses. In the current report, we review a case of a methamphetamine user who attempted suicide by jumping off a bridge. Further, we contextualize this case by reviewing recent literature on the relationship between methamphetamine use and suicide.

The expansive spectrum of major depressive disorder (MDD) continues to pose challenges for psychiatrists to treat effectively. Oral antidepressant (OAD) medications that alter monoamine neurotransmitters, mainly selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), have been the mainstay of therapy for decades. Although these drugs have been largely beneficial, a considerable subset of patients do not respond adequately to multiple conventional therapies administered for an appropriate length of time, leading to a diagnosis of treatment-resistant depression (TRD). Ketamine, a non-monoaminergic drug, has long been known for its beneficial effects on TRD when given intravenously (IV). Between 2019 and 2020, an intranasal formulation of the S (+) enantiomer of racemic ketamine, esketamine (ESK), was granted \"breakthrough designation\" by the FDA and approved for the indications of TRD and MDD patients exhibiting acute suicidal intent. The objective of this narrative review was to review the academic literature and collect clinical evidence that may corroborate intranasal ESK\'s effectiveness for its approved indications while addressing its safety and tolerability profile, adverse effects, and impact on cognition. An overview of the drug\'s origins, pharmacology, and standard treatment regimen are provided. The outcomes from double-blinded randomized control trials (DB-RCTs) of ESK are outlined to demonstrate the efficacy and safety data leading to its FDA approval, along with its long-term post-market safety outcomes. Comparative trials between ESK and ketamine are then evaluated to highlight ESK\'s consideration as a more practical alternative to ketamine in common clinical practice. The authors further discuss currently approved and developing therapies for TRD, propose future research directions, and identify the inherent limitations of the review and further research. To conduct the research required, three digital databases (PubMed, Medline, and ClinicalTrials.gov) were queried to search for key terms, including ketamine, esketamine, treatment-resistant depression, and biomarkers, using automation tools along with selective search engine results. After streamlining the results by title and abstract and removing duplicates, a total of 37 results were chosen, of which 18 are clinical trials. A reduction in the Montgomery-Asberg Depression Rating Scale (MADRS) score was the primary efficacy endpoint for most of these clinical trials. In conclusion, intranasal ESK, when used as an adjunct to market OADs, shows greater efficacy in treating TRD and MDD with suicidal intent compared to OADs and placebo alone and provides a more suitable alternative to IV ketamine. It is important to note that further research is required to fully understand the novel mechanism of action of ESK, as well as the establishment of a consensus definition of TRD, which may facilitate better detection and treatment protocols. More focused quantitative and qualitative ESK studies are needed, as well as those pertaining to its use in patients with co-existing mental illnesses.

Background Depressive disorders have a prevalence of 322 million people worldwide and are a leading cause of morbidity. These disorders can affect individuals of all ages and can present over time. Due to the diversity in the presentation of depressive disorders, vigilance towards depressive disorders can lead to more timely and effective treatment. Serotonin Selective Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) are the first lines of treatment for these disorders. Moreover, the United States Food and Drug Administration (FDA) issued a black-box warning for several antidepressants, stating an increased risk of suicidality in individuals under 25 years old. However, the placement of this black-box warning has been controversial. In this study, the authors aim to investigate if there is a relationship between the use of SSRI or SNRI on patients with newly diagnosed depressive disorder and hospital readmission due to suicide-related events.  Methods For this retrospective cohort study, de-identified data were obtained from the HCA Healthcare database by searching for patients newly diagnosed with depressive disorders and started on SSRIs or SNRIs. Patient data were evaluated for readmissions due to suicide-related events within 90 days of discharge from the hospital and establishing their initial SSRI/SNRI prescription.  Results After data was obtained and evaluated via statistical analysis, the variables with statistical significance were: age (p-value = 0.0164) and sex (p-value = 0.0150). These two were significantly associated with the rate of readmission: younger and male patients had an increased risk of readmission due to suicide-related events within 90 days of discharge after starting SSRI, or SNRI, to treat depressive disorders. Conclusion These results support the importance of monitoring patients started on SSRI or SNRI, with particularly careful consideration in depressed young male patients.

Opioid toxicity can result in life-threatening respiratory depression. Opioid-overdose mortality in the United States is high and increasing, but it is difficult to determine what proportion of those deaths might actually be suicides. The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remains unknown. It is important to differentiate between those who take opioids with the deliberate and unequivocal objective of committing suicide, that is, those with active intent, from those with passive intent. The passive-intent group understands the risks of opioid consumption and takes dangerous amounts, but with a more ambiguous attitude toward suicide. Thus, among decedents of opioid overdose, a large population dies by accident, whereas a small population dies intending to commit suicide; but between them exists a sub-population with equivocal intentions, waxing and waning between their desire to live and the carelessness about death. There may be a passive as well as active intent to commit suicide, but less is known about the passive motivation. It is important for public health efforts aimed at reducing both suicides and opioid-use disorder to better understand the range of motivations behind opioid-related suicides and how to combat them.

Raynaud\'s phenomenon (RP) is a medical condition characterized by vasospasm of the digital vessels in the fingers and toes. The prevalence of RP in the general population is estimated at 3-5% and can vary based on climate. It is classified into primary and secondary RP based on causality. RP has been reported in some cases diagnosed with coronavirus disease 2019 (COVID-19) infection. We report the case of a 14-year-old Caucasian female who presented during the pandemic with chief complaints of suicidal ideations and attempted suicide and had a history of attention-deficit hyperactivity disorder (ADHD) and persistent RP after a stimulant trial. After an initial failure of treatment with lisdexamfetamine, she was switched to methylphenidate hydrochloride (MPH). Within two months of starting MPH, the patient noticed skin discoloration of the lower legs and feet along with numbness. The discoloration of skin was mainly limited to her feet and gradually moved up her legs. She was advised to discontinue the MPH, but her symptoms persisted for four more months until her admission. Other etiologies were ruled out by multi-specialties and during her hospitalization. She was started on atomoxetine and buspirone with appropriate dose titration. Post-discharge from the hospital, no improvement was observed in the patient\'s RP at an outpatient follow-up performed within a month. The development of RP following MPH treatment and its persistence after stopping MPH is a fascinating event. Clinicians should be aware of the potential rare side effects of stimulants and stimulant-like medications, including vascular, hematological, and dermatological effects. Adolescents with ADHD may be particularly distressed by the COVID-19 pandemic and display increased behavioral issues. Stress can be a trigger for RP; therefore, minimizing stress in at-risk patients is essential.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. Women with PCOS may present with obesity, amenorrhea, oligomenorrhea, infertility, or androgenic features. Studies have shown the association of psychiatric disorders with endocrine disorders, including PCOS. We present a case of a PCOS patient with no prior psychiatric history who presented with suicidal ideation. We emphasize the importance of screening women for PCOS when presented with mental disorders through this clinical case. It is crucial to rule out any medical causes in patients predominantly presented with psychiatric symptoms. We highlight the possible role of bupropion and naltrexone in managing PCOS symptoms, depression with suicidal ideation, and trichotillomania through this unique and rare case.

According to the World Health Organization (WHO), chronic diseases are the leading cause of death and disability worldwide and estimated to contribute to 73% of all deaths by 2020. In addition to the difficulty in effectively managing chronic diseases, they are often complicated further by the co-morbid depression stemming from the original disease. Depression has the highest burden of disease affecting more than 264 million people worldwide and worsens the burden of co-existing chronic medical diseases as well. A bidirectional relation exists between depression and chronic medical diseases. Statistical mapping of chronically ill patients of Pakistan suggests that 50% of its population suffers from some form of chronic disease. Little data exists for the prevalence of depression in chronically ill patients from most of Pakistan. Our objectives were to observe the patterns of depression in chronically ill patients and outline the need for intervention (if any) on a population of Railway General Hospital (RGH - a tertiary healthcare hospital in Rawalpindi, Pakistan). We also aimed at finding out the relation (if any) of age, gender, number of hospital admissions, education and effectiveness of medical disease management with depression. A cross sectional study was conducted on patients admitted due to their chronic medical diseases out of a population of 11,000 presenting at the medical OPD of RGH over a period of three months using Patient Health Questionnaire-9 (PHQ -9) Urdu version. About 50% of the patients suffered from moderate to severe forms of depression. A significant positive correlation was found between age and past psychiatric history of illnesses other than depression with depression while no significance was found with number of hospital admissions, gender or education level; 35% had suicidal ideation. Depression is quite often dismissed, underdiagnosed and leads to a poor quality of life and decrease in cost effectiveness in our population. Pakistan needs to use more resources on managing depression and medical professionals need to change their attitudes in holistically managing the patients. Treating depression is just as important as managing other symptoms of chronic medical diseases.

Objective The aim of this study was to evaluate the odds of association between suicidal behaviors and comorbid anxiety disorders in adolescents with major depressive disorder (MDD). Methods We included 122,020 adolescent inpatients with MDD from the Nationwide Inpatient Sample (NIS) and further grouped them by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety disorders. Results Out of total MDD inpatients, 45.8% had comorbid anxiety disorders. Around 53.5% MDD inpatients with anxiety disorders had suicidal behaviors, which were significantly higher than seen in 52.6% non-anxiety cohort (P = 0.002). Comorbid anxiety disorders had a minimally positive association with suicidal behaviors and were not statistically significant (OR: 1.01; P = 0.710) after controlling the logistic regression analysis for demographic confounders and psychiatric comorbidities. MDD inpatients with comorbid psychotic disorders were positively associated (OR: 1.16; P = 0.007) with suicidal behaviors. Conclusions MDD with comorbid anxiety had a statistically non-significant association with suicidal behaviors in adolescents. Depression has a direct and independent effect on adolescent suicidal behaviors, whereas anxiety has a direct effect only on perpetuating depression. Early diagnosis and management of comorbid anxiety and psychosis with MDD reduce functional impairment and suicide risk in at-risk populations.