Indian Journal of Psychiatry最新文献

Background: Comparison of available first line agents for treating Erectile Dysfunction (ED) with each other regarding efficacy in Indian context remains scant. Sexual and mental health disorders frequently overlap and it is prudent to explore the potential of these medications to improve common comorbid psychiatric symptoms.

Aim: To compare the efficacy of on-demand Sildenafil, on-demand Tadalafil and daily Tadalafil for ED, as well as their impact on premature ejaculation (PME) and mental health.

Methods: Seventy-five individuals diagnosed with ED (ICD-11) were randomly assigned to one of the three treatment groups with 25 participants in each group: Group A (Sildenafil 50-100 mg SOS), Group B (Tadalafil 10-20 mg SOS), and Group C (Tadalafil 5 mg daily). Severity of sexual functioning was evaluated using the International Index of Erectile Function (IIEF), Sexual Encounter Profile question 2 and 3 (SEP2/3), Premature Ejaculation Diagnostic Tool (PEDT). Depression, Anxiety, and Stress Scale (DASS-21) assessed mental health status. Assessments were repeated at 2 weeks intervals till 12 weeks. Blood investigations were carried out at baseline and at the end of study period.

Results: Daily Tadalafil was superior to on-demand Sildenafil or Tadalafil in improving erectile function (P < 0.05), particularly in penetration (SEP 2/3) and was equally effective as on-demand Tadalafil on IIEF, while outperforming Sildenafil. It also significantly reduced depression and anxiety symptoms at 12 weeks (P < 0.05). On-demand Tadalafil was most effective for managing associated PME, which was comorbid with ED in 66.7% of cases.

Conclusion: Daily Tadalafil was more effective than on-demand Tadalafil or Sildenafil for treating ED, especially in patients with mood symptoms. PME was found to be quite common with ED and responded best to on demand Tadalafil. Tadalafil was superior to Sildenafil in all domains.

Background: Delirium is an acute neuropsychiatric syndrome with variable presentations depending on etiology. Alcohol withdrawal delirium (AWD) typically presents as hyperactive subtype, while non-alcohol withdrawal delirium (NAWD) is more heterogeneous.

Aim: To compare clinical patterns and severity of delirium in AWD and NAWD in a rural tertiary care hospital.

Methods: A cross-sectional study of 120 patients with delirium referred for psychiatric evaluation was carried out. Delirium Etiology Checklist, Richmond Agitation Sedation Scale (RASS), and Delirium Rating Scale-Revised-98 (DRS-R-98) were the tools used. Statistical analysis employed SPSS v 27.0.

Results: AWD accounted for 17% of cases, all hyperactive, while NAWD showed mixed patterns of presentation. DRS-R-98 scores were significantly higher in AWD. Hypoactive delirium correlated with sepsis and cardiac decompensation.

Conclusion: AWD demonstrates severe hyperactive features, while NAWD is varied and frequently hypoactive, underscoring the need for tailored approaches in resource-limited settings.

Patient and public involvement (PPI) is increasingly mandated in clinical research globally, reflected in recent updates to the CONSORT 2025 and SPIRIT 2025 guidelines, which now require structured reporting of PPI activities. These developments signal a shift toward inclusive, accountable, and co-produced research, recognizing the value of experiential knowledge in improving trial relevance and impact. However, Indian mental health clinical trials have yet to meaningfully adopt PPI, despite growing evidence of its feasibility and value in low- and middle-income countries. This commentary critically examines the current state of PPI in Indian mental health trials, drawing insights from two prominent studies-the MANAS and ARTEMIS trials. While both incorporate some elements of stakeholder engagement, they stop short of full co-production and lack formal integration of persons with lived experience (PWLE) in governance, evaluation, or authorship. We identify systemic, cultural, and operational barriers to authentic PPI and propose strategic pathways to embed it in Indian mental health research. These include mandating PPI in funding requirements, integrating it into ethical oversight, building capacity among researchers and PWLE, and adapting reporting tools like GRIPP2 for Indian contexts. Embedding PPI is both an ethical imperative and a scientific opportunity to strengthen mental health trials and their implementation.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) and borderline personality disorder (BPD) are psychiatric conditions commonly associated with impulsivity and substance use. Both disorders are linked to substance use (SU), which includes patterns of consumption of substances such as alcohol, tobacco, and illicit drugs.

Objective: The primary objective is to examine the association between SU and the presence of ADHD and BPD traits among undergraduate students in Eastern Odisha. Additionally, this study aims to estimate the prevalence of ADHD, BPD, SU, and impulsivity within this population; investigate the patterns and types of substances commonly used by students; and evaluate the relationship between impulsivity traits and ADHD, BPD, and SU.

Methods: A cross-sectional study was conducted involving 887 undergraduate students aged 18-26 at a university in Bhubaneswar, Eastern Odisha. Participants completed standardized instruments, including the Adult ADHD Self-Report Scale (ASRS-v1.1), the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), the Barratt Impulsiveness Scale (BIS-11), and the DSM-5 criteria for substance use disorder (SUD). Associations were analyzed using Chi-square tests and odds ratios.

Results: The findings indicated a prevalence of ADHD at 3%, BPD at 5%, and SU at 18%. Impulsivity was highly prevalent, reported in 71% of individuals with ADHD, 64% with BPD, and 51% with SU. ADHD was significantly associated with substance use disorder (SUD) (OR = 10.57, 95% CI: 4.68-23.83), with 68% of individuals with ADHD screening positive for SUD (P < 0.001). Similarly, BPD was significantly correlated with SU (OR = 4.54, 95% CI: 2.44-8.43; P < 0.001). Substance use patterns differed between ADHD and BPD, with tobacco and cannabis most strongly linked to BPD, while alcohol showed modest diagnostic specificity.

Conclusion: The current study found that substance use was prevalent among undergraduates, with strong associations observed between ADHD and SU, as well as between BPD and SU. These findings highlight distinct SU patterns linked to each disorder. Impulsivity was identified as a common underlying factor across ADHD, BPD, and SU.

Background: There has been a consistent increase in the use of transcranial direct current stimulation (tDCS) in psychiatric practice and academic research in India. However, no systematic effort has been made to map the trajectory of clinical research involving tDCS within Indian institutions.

Methods: PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for tDCS studies with Indian affiliations published until May 2025.

Results: Data on study design, diagnosis, stimulation parameters, authorship, institutions, and funding were analyzed. A total of 106 studies were included. Most publications were case reports (37.4%), followed by interventional studies (27.1%) and randomized controlled trials (26.2%). Schizophrenia (36.4%) and obsessive-compulsive disorder (OCD) (10.3%) were the most studied conditions. The left dorsolateral prefrontal cortex (DLPFC) was the most targeted site (53.8%). Conventional tDCS was used in 57.5% of studies.

Conclusion: Indian tDCS research in psychiatry is increasing but remains limited compared to global trends.

Background: Teenagers and young adults (TYA) with autism spectrum disorder (ASD) in India face systemic barriers in education, employment, and healthcare, worsened by the lack of culturally tailored services.

Aim: This study aimed to design and validate a culturally sensitive assessment framework for TYA with ASD, incorporating expert and caregiver input to identify barriers and inform scalable interventions.

Methods: Using an operational research design, we integrated real-time interventions with a three-tiered assessment framework (clinical, home-based, and community evaluations). Forty-three participants aged ≥14 years were recruited via convenience sampling. Standardized tools (Vineland Adaptive Behavior Scale-2, DSM-5 Clinician-Rated Severity, Wechsler Abbreviated Scale of Intelligence-II) and structured interviews guided individualized interventions, including behavioral, pharmacological, and vocational strategies. Manual thematic analysis with inter-coder reliability provided qualitative insights.

Results: Significant psychiatric comorbidities were found in 82.9% of participants [e.g. Intellectual Disability, Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety], alongside high school dropout rates (31.7%) due to the behavioral and academic challenges, and limited vocational training access (17%). Gender disparities showed males with externalizing behaviors and females often underdiagnosed due to internalizing symptoms. Families reported financial strain, caregiver burnout, and social isolation, with siblings experiencing both neglect and support roles. Thematic analysis highlighted needs for family support networks, sexuality education, and vocational day centers, leading to targeted services launched in November 2024.

Conclusion: This study, one of India's first to combine multidisciplinary assessments with real-time interventions, offers a replicable framework for scalable, family-centered ASD care. It underscores the need for adaptive policies and targeted interventions to address systemic barriers in education, mental health, and vocational integration for TYA with ASD.