Indian Journal of Psychiatry最新文献

Modern studies have revealed various pathophysiological mechanisms underlying neurodegenerative dementias. Among these, disruption of the "triple mode network" is widely recognized as a pivotal common pathway leading to the development of the neurodegenerative dementias including Alzheimer's dementia. Contemporary studies have shown strong association of impaired social cognition with various dementias. However, how the misaligned social cognition leads to neurocognitive decline is still enigmatic. Herein, the authors introduce the term "triple-layered model of social cognition", which encompasses the three pillars, that is, the basic "core cognitive constructs", the value-based "higher-level cognitive constructs", and instinct-driven "lower-level cognitive constructs (i.e., the bottom circuit)". Dynamic interactions between the complex engrams of all three pillars form the "cogniverse". The "higher-level cognitive constructs" may serve as a protective layer for the foundational "core cognitive constructs", which are incessantly challenged by "the bottom circuit". This could be a critical harbinger of neurocognitive decline. The authors further hypothesize that the derivatives of the miscalibrated social cognition, emerging from "the bottom circuit", serve as "cognitive pollutants". Here, authors introduce the term "social proteopathy" encompassing all social cognitive pollutants as a unified concept, which plays a significant pathological role in neurodegenerative dementias alongside biologically and genetically linked proteopathies. These social proteopathies have a profound deleterious impact on the "higher-level cognitive constructs" either through direct toxic potentials or via epigenetic modulation. Misdirected and maladaptive social cognition progressively erodes the layer of "higher-level cognitive constructs", eventually having a deleterious impact on the fundamental "core cognitive constructs", which, in turn, contribute to neurodegenerative dementias and various psychopathologies. The authors further attempt to classify "social brain" into six subtypes to assess the future "social cognitive debt" and the resulting aberrant behavioral burdens. Finally, the authors propose the way forward including genuine mindfulness-based practice and relentless exercise of the "higher-level cognitive constructs" in activities of daily living. This may act as a primordial preventive strategy against neurodegenerative dementias and various psychopathologies.

This viewpoint draws attention to the disparities that exist between the Rights of Persons with Disabilities Act, 2016 and the facilities that are available to specialists on the digital platform of certification for mental illnesses to address the severity of the impairment. It also recognizes that the lack of clear rules makes it difficult to reevaluate both single and multiple disabilities. The process of disability certification is further complicated by other factors, including inadequate training of medical professionals and clerical staff, server associated delays as well as the lack of uniformity of standard operating procedures among disability centers across the country.

Background: Chronic stress is a well-established factor influencing unhealthy eating behaviors. Anxiety has been linked to emotional eating and acts as a mediator between depression and body mass index. However, the interaction between negative affectivity and eating behavior may vary across different life stages, suggesting that these relationships could differ between age groups.

Aim: The study aimed to explore whether the relationship between negative affective states and eating behavior differs between young adults and middle-aged adults.

Materials and methods: A cross-sectional study was conducted among 172 participants: 87 young adults and 85 middle-aged adults. Sociodemographic data were collected, and participants completed the Depression Anxiety Stress Scales (DASS-21), Adult Eating Behavior Questionnaire, Spanish version (AEBQ-Esp), and the Emotional Eating Scale.

Results: Young adults exhibited significantly higher levels of negative affectivity compared to middle-aged adults (d = 0.39), although differences in eating behavior were only observed in the dimension of eating slowness (d = -0.37). A negative correlation was found between negative affectivity and the family dimension of emotional eating in young adults (r = -0.332), while a positive correlation emerged in middle-aged adults (r = 0.259). The analysis by age groups revealed distinct patterns of association between stress and dimensions of eating behavior and emotional eating, with stress showing the most robust associations.

Conclusions: The findings indicate that, while negative affective states are associated with emotional eating in both age groups, the nature of these associations varies significantly. In some cases, the same factor may serve as a risk factor in one age group and a protective factor in another.

Background: Depression is a major public health problem in India, placing a substantial burden on individuals, families, and society. Besides clinical assessment, quality of life (QoL) and out-of-pocket expenditure (OOPE) are key measures to assess the impact of this condition on a patient's wellbeing. However, there is a dearth of published evidence on both these outcomes from India. Moreover, there is no evidence of concordance between common tools for measuring QoL in patients with depression in Indian settings.

Aim: This study aims to assess QoL using the EQ-5D-5L and WHOQOL-BREF tools, estimate OOPE for depression care, identify factors associated with QoL and OOPE, and explore the correlation between the QoL derived from both tools.

Methods: A cross-sectional survey was conducted at a public tertiary care facility in India, involving semistructured interviews with 259 depression patients. Mean QoL and OOPE were estimated. Multiple linear regression was employed to identify factors associated with QoL and OOPE, while Pearson's correlation coefficient was used to assess the relationship between EQ-5D-5L and WHOQOL-BREF domain scores.

Results: The mean EQ-5D-5L utility score was 0.731, while the QoL derived from WHOQOL-BREF ranged from 50.41 to 61.00, across the four domains. Factors like depression severity, perceived support, physical activity, and literacy were significantly associated with QoL. The annual OOPE for depression treatment was ₹35,101. Moderate to strong correlations were observed between EQ-5D-5L and WHOQOL-BREF "physical health" (r = 0.605) and "psychological" (r = 0.553) domains, with weaker correlations for "social relationships" (r = 0.255) and "environment" (r = 0.292).

Conclusion: Depression leads to significant financial burden on the patient and the family and is associated with lower QoL. Future research should explore the addition of relevant bolt-on dimensions to the EQ-5D-5L to improve its sensitivity in depression assessment.

In this article, the second of a series on rating scale translation, adaptation, and psychometric testing, we focus on reliability testing of a rating scale. Reliability refers to the consistency of results when the scale is reapplied to or completed by the same individual again under the same conditions. We discuss three key types of reliability: internal consistency, test-retest reliability, and inter-rater reliability testing. The appropriate measure for reporting internal consistency is Cronbach's alpha (α); for test-retest reliability, it is the intraclass correlation coefficient (ICC) for continuous variables and intraclass kappa for categorical variables. For inter-rater reliability, the preferred measure is either Cohen's kappa (κ) in case of categorical variables with two raters or the ICC for continuous variables; depending on the randomness in the selection of raters, different statistical models are used for computing the ICC. This article presents these concepts with simple, non-technical explanations. We also address practical considerations for conducting reliability tests, explain how to choose the right statistical index for each type of reliability, and clarify common misapplications. Finally, we offer guidance on interpreting and reporting reliability test results in a manuscript, along with instructions on conducting these analyses using IBM SPSS Statistics.

Background: According to the International Classification of Diseases-10, postnatal depression (PND) is the presence of depressive symptoms that develop within 6 weeks of delivery. Only a few studies conducted in India have reported the incidence of PND in rural communities.

Aim: To determine the incidence of postnatal depression and its risk factors in a rural area of northern India.

Methods: A prospective cohort study was conducted on 232 postnatal women from a rural area of northern India. These women were enrolled as they were screened negative for PND using the Edinburgh Postnatal Depression Scale (EPDS) within 7 days of delivery and were again followed up at 6 weeks to find the incidence of PND. A score ≥10 was considered positive for PND.

Results: Out of 290 postnatal women screened within 7 days of delivery, 58 were positive for PND (20.0%). Of 232 postnatal women, with a mean age of 25.0 ± 4.2 years, screened negative, 227 were followed up at 6 weeks, and 31 women were found to have developed PND (13.7%). PND was seen to be significantly associated with the husband's substance use, presence of sadness during the antenatal period, unsatisfaction with the marital relationship, unsatisfaction with the sex of the infant, low birth weight of the infant, and history of hospital admission of infant in the first 6 weeks (P value < 0.05).

Conclusion: PND is a public health concern for which antenatal and postnatal women should be screened, counseled, and treated for PND at the primary healthcare level in India.

The population of some Indian states is equivalent to that of many low- and middle-income countries (LMICs). Due to India's federal administration system, states manage their health services independently, and their unique social, economic, and governance circumstances influence their development trajectories. The current practice of Global Mental Health is to scale up evidence-based interventions. In this research, scaling up is defined as the development of the mental health (MH) service system, which, in turn, is considered an organic part of health service systems strengthening within the enduring ethos of the Alma Ata Declaration and Sustainable Developmental Goals. The current analysis uses a comparative health system lens to explore the status of MH services in selected states of India with the development of the health system. The authors tentatively conclude that for India and similar LMICs, the advancement of the MH system/services is best addressed through health system development utilizing principles of Primary Health Care.