Indian Journal of Psychiatry最新文献

Background: Decision-making capacity (DMC) is central to informed consent and patient autonomy in psychiatric practice. While impaired DMC is common among inpatients, the relative contributions of insight, severity of illness (SoI), and socio-demographic factors remain less explored, particularly in the low- and middle-income countries.

Aim: To identify the socio-demographic and clinical correlates of DMC among psychiatric inpatients at the time of admission.

Methods: Psychiatric inpatients (N = 233) were assessed at the time of admission for DMC using the guidance document. Data on socio-demographic characteristics, family psychiatric history, duration of illness, psychiatric diagnosis as per ICD-11 diagnostic criteria, SoI using brief psychiatric rating scale (BPRS), and clinical grading of insight were recorded. Logistic regression, receiver operating characteristic (ROC), and precision-recall curve (PRC) analyses was used to identify baseline correlates of DMC.

Results: Family history of psychiatric illness, being single, absent clinical insight and higher SoI (BPRS > 31) showed significant association with incapacity at baseline. In multivariable models, higher grades of clinical insight alone showed 85-times more likelihood for preserved DMC; and upon including SoI into the model-lower BPRS scores ≤31 showed 33-times more likelihood to have preserved DMC, while higher grades of insight further increased the likelihood to 139-fold, after adjusting for other variables. Overall, insight and SoI accounted for 91% of the variance, with an overall classification accuracy of 97.4%. ROC and PRC analysis identified an insight grade ≥2 as the optimal cut-off, with 87.3% precision, 94.8% sensitivity (recall), and 95.4% specificity.

Conclusion: Clinical insight (≥2) is the strongest correlate of preserved DMC in psychiatric inpatients, with SoI (BPRS ≤ 31) providing an additional influence, at baseline. Routine context-specific structured assessments of insight and SoI should be integrated into psychiatric evaluations for DMC to improve objectivity, and support patient autonomy.

Background: No Indian study has profiled adolescents with addictive disorders in rehabilitation.

Aim: Hence, this study aimed to describe sociodemographic and clinical profiles of adolescent boys in short-term rehabilitation.

Methods: A retrospective chart review was conducted, including the scores on Disruptive Behaviour Disorders (DBDs) Rating Scale, for 59 patients, over 16 months.

Results: Mean age of first use of nicotine, alcohol, and cannabis was 12.1 ± 2.7, 13.6 ± 1.7, and 14.3 ± 1.4 years, respectively. Of the patients, 57.6% were from broken families, 59.3% had experienced childhood adversities, 49.2% had parental psychiatric history, 10.2% had only behavioural addictions, 84.7% had dual diagnosis, and 79.7% had comorbid DBD, the commonest being conduct-dissocial disorder (in 47.5%).

Conclusion: Earlier onset of substance use was associated with lower socioeconomic status (SES) (P = 0.003) and poor parental supervision (P = 0.017). Clinicians should screen for dual diagnoses and target prevention for broken families, childhood adversities, poor parental supervision, and low SES.

Background: Cluster randomized trials (CRTs) reduce intervention contamination but may compromise statistical efficiency. Although Consolidated Standards of Reporting Trials (CONSORT) guidelines recommend reporting intraclass correlation coefficients (ICCs), compliance is limited.

Aim: This meta-analysis attempts to estimate the pooled ICC of CRTs on anxiety disorders.

Results: A systematic search in various databases yielded 1,124 citations, qualifying 23 studies for meta-analysis upon further screening. DerSimonian and Laird's inverse variance method was used to calculate the pooled estimates. Among 23 studies, 16 reported ICCs at the design stage, with no significant difference compared to post-intervention values. The pooled ICC was 0.05 (95% CI: 0.04-0.06) with substantial heterogeneity; funnel plot asymmetry suggested publication bias, though Egger's test found no small-study effects (P = 0.913).

Conclusion: Only two-thirds of CRTs on anxiety disorders complied with CONSORT recommendations on ICC reporting. The pooled ICC from this meta-analysis provides a reference for sample size estimations in future CRTs targeting anxiety disorders.

The intraclass correlation coefficient (ICC) is a measure of reliability that is available in many forms, classified as one-way or two-way, random or mixed model, for single measures or as a mean of k measures, and as values for consistency or absolute agreement. Different forms of the ICC are appropriate in different clinical research contexts; each form has its own formula and interpretation. Literature on the ICC is sparse, and so concepts related to this statistic tend to be poorly understood, possibly resulting in a wrong form being used, and commonly resulting in poor reporting of the statistic in research papers. This article therefore explains the ICC and its forms in simple language, with examples where required. Practical guidance is provided for use and interpretation of the ICC. For most studies of test-retest reliability, or inter-rater reliability, the two-way mixed model ICC for single measures is appropriate, and the absolute agreement, along with its 95% confidence interval, should be reported.

Background: Medical students globally experience high levels of stress during training, often leading to anxiety and depression. Many students with mental health concerns do not seek treatment. Thus, understanding the barriers to accessing mental health care is crucial.

Aims: To identify the barriers to seeking professional mental health care among medical students in central India.

Method: This cross-sectional study was conducted among 409 medical students at a tertiary care hospital in central India. The barriers to seeking mental health care were assessed using the Barrier to Access to Care Evaluation (BACE) scale. Qualitative data were gathered through open-ended question. The multivariate binary logistic regression model was performed to determine the factors associated with the practice of not seeking mental health care despite the need, along with descriptive analysis.

Results: One-fourth of the participants reported not seeking care for mental health illness despite having need. Major barriers identified included attitudinal factors, such as wanting to solve problems independently (83.6%) and believing the problem would improve on its own (68.9%). Stigma-related barriers involved concerns about family perceptions (44.5%) and fear of being seen as weak (43.3%). Instrumental barriers included financial costs (23.5%) and lack of support (23.5%). Moderate psychological distress was associated with nearly five times higher odds, severe distress with nearly seven times higher odds of not seeking professional help.

Conclusion: The study highlights significant attitudinal and stigma-related barriers preventing medical students from seeking mental health care. These findings underscore the need for institutional policies promoting mental health literacy, destigmatization, and early intervention to improve mental health outcomes and ensure the well-being of medical students.

Background: The menopausal transition is associated with hormonal, cognitive, and autonomic changes, yet the interplay between cognitive function and autonomic regulation-measured via heart rate variability (HRV) remains underexplored in Indian women.

Aims: The study aimed to compare cognitive performance and HRV parameters between reproductive-age and post-menopausal women, and to assess the relationship between cognitive domains and HRV indices.

Methods: A cross-sectional study was conducted at a tertiary care center of Northern India, enrolling 240 healthy women (120 reproductive-age, 20-40 years; 120 post-menopausal, 45-60 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), while HRV was evaluated via 5-min resting ECG. Time-domain [standard deviation of NN interval (SDNN), root mean square of successive differences (RMSSD), proportion of NN50 (pNN50), mean RR] and frequency-domain [low-frequency (LF) and high-frequency (HF), LF/HF ratio] HRV metrics were analyzed.

Results: Post-menopausal women showed significantly lower MoCA scores than reproductive-age women (22.35 ± 3.17 vs. 25.54 ± 2.34, P < 0.001), with pronounced deficits in executive function, memory, and abstraction. Interestingly, the language domain score was significantly higher in the post-menopausal group. HRV analysis revealed significantly longer RR intervals and higher parasympathetic indices (RMSSD, pNN50, HF power) in post-menopausal women, while LF-power was lower; however, LF/HF ratio remained unchanged between groups (P = 0.96). Positive correlations were observed between MoCA scores and SDNN, mean RR; LF/HF ratio correlated negatively with cognitive scores in both groups.

Conclusion: Post-menopausal women exhibited cognitive deficits-particularly in executive and memory domains-alongside distinct alterations in autonomic function. Contrary to expectations, HRV parameters indicated preserved or enhanced parasympathetic modulation in the older group. These findings underscore the relevance of autonomic-cognitive coupling in aging women and support HRV can be a potential biomarker of cognitive health.

Objective: To compare the pathways to care of patients attending a tertiary care psychiatry hospital with those attending a hospital-based deaddiction camp.

Methods: Pathways to care were compared among 155 patients with alcohol use disorders (AUDs) across two settings: a tertiary care hospital (n = 110) and a hospital-based deaddiction camp (n = 45). Data were collected using a sociodemographic questionnaire, the modified Kuppuswamy socioeconomic status scale, the WHO Encounter Form, and the alcohol use disorders identification test (AUDIT).

Results: Sixty-nine percent of patients attending the hospital-based deaddiction camp first consulted a psychiatrist, compared with only 9% of patients attending the tertiary care hospital. Consultation with religious or other indigenous service providers was low in both groups. A significant difference was observed in the decision-makers at each point of service between the two groups (P < 0.001).

Conclusion: Patients with AUDs attending the tertiary care hospital and the deaddiction camp followed distinct pathways to care and demonstrated different treatment needs.