Indian Journal of Psychiatry最新文献

Background: Adolescents in low-middle-income countries face increasing physical and mental health challenges. The present study aimed to assess status of injury, verbal abuse, substance use, and emotional behavior of adolescents of Uttarakhand, India, and evaluate the importance of each component.

Methods: A cross-sectional study was conducted among adolescents in 13 government schools in Uttarakhand using the Global School-based Health Survey (GSHS). Categorical principal component analysis (CATPCA) using Varimax rotation was performed to analyze principal components among two domains of GSHS (substance abuse domain and verbal abuse and emotional behavior domain). Factorability was assessed using Kaiser-Meyer-Olkin and Bartlett's test. Variance Accounted For index was used to evaluate the importance of each component.

Results: A total of 634 adolescents completed the questionnaire. 41.3% students suffered from serious injury with a significant difference (P < 0.0001) between both genders. Girls were more likely to report having felt lonely most of the time or always in the past 12 months (11.0% vs 4.6%, P = 0.018). Boys were more likely to miss classes on 3 or more days (9.9% vs 4.9%, P = 0.043). Initiation of smoking cigarettes (9.6% vs 1.2%, P <0.0001) and tobacco chewing (3.4% vs 0.3%, P = 0.001) was more likely in 12-15-year-old boys. One-third of the students reported male guardians to use either alcohol or some form of tobacco. CATPCA yielded an 11-factor model accounting for 58.26% of variances with the most important principal component named "Tobacco (Smoking and Chewing): Initiation, Frequency and Attempt to Stop" (eigenvalue: 4.109).

Conclusion: Significant differences in various items of injury, verbal abuse, substance use, and emotional behavior were recorded between boys and girls. CATPCA revealed patterns among injury, verbal abuse, emotional behavior, and substance abuse domains of GSHS by categorizing them into 11 components. On the basis of these patterns, prioritizing and development of appropriate school-based interventions may be implemented by various stakeholders of Uttarakhand.

Normal pressure hydrocephalus (NPH) usually presents with progressive gait impairment, urinary incontinence, and cognitive deficits. Many studies have shown that NPH can mimic other disorders like Parkinson disease with tremors and rigidity. In this report, we present our experience with three patients who had psychotic behavior and were treated with psychiatric medications but were subsequently investigated and found to have NPH. After lumboperitoneal shunting, all the three became normal and were even able to stop the psychiatric medications completely. The message is that NPH can mimic a psychiatric disorder and awareness about this well treatable condition is important especially among the psychiatrists and geriatricians.

Background: Obsessive compulsive disorder (OCD) causes impairment in social and academic functionality. Intensive treatment methods such as day treatments are recommended in resistant cases.

Aims: The aim of this study is to examine the changes in treatment responses according to gender in children and adolescents with OCD who are followed up in the day clinic and to evaluate the factors that predict treatment.

Methods: Adolescents with OCD (n = 50) who were followed up in the day clinic between 2007 and 2021 were included in this study. Scales evaluating symptom severity and treatment responses were administered to the patients at admission and discharge.

Results: The mean age of the adolescents included in the study was 14.24 (SD: 2.1). The mean length of stay in the day clinic was 8.3 (SD: 0.1) weeks. When the factors related to the treatment response were evaluated, a significant correlation was found between the length of stay in the day clinic and improvement.

Conclusions: This study provides evidence for the importance of intensive treatment in adolescents experiencing severe OCD symptoms. Ensuring that intensive treatments such as day clinics become widespread and standardizing these treatments will provide important developments in the treatment of OCD.

Background: Telemedicine-assisted buprenorphine (BNX) induction (TABI) has the potential to reduce the treatment gap for opioid use disorder.

Aim: This study investigated the acceptability and feasibility of TABI in India. This was a retrospective study from a specialized addiction treatment center in a teaching hospital.

Methods: TABI was introduced in November 2022; patients enrolled till May 2023 were included in the analysis. Feasibility was assessed by the proportion of patients who completed the TABI program, continued treatment for at least 3 months, and self-reported nonprescription opioid use during and after TABI. Acceptability was measured by patient satisfaction with TABI.

Results: Sixty patients were enrolled: Fifty-three patients (88.3%) were retained during the TABI program, and 50 patients (83.3%) remained in treatment at the 3-month follow-up. Thirty-five patients (58.3%) reported using nonprescription opioids during TABI, and 28 patients (46.7%) reported such use after completing the program. Thirty-five (58.3%) were satisfied with the program, and 15 (25%) said they would recommend it to others. Patients who missed scheduled in-person appointments (P < .001) at 1 week, did not return unused BNX-naloxone (P < .001), and were not satisfied (P = .004) were more likely to report nonprescription opioid use. Those who attended the in-person follow-up at 1 week (P = .004) and were satisfied (P = .01) and did not use nonprescription opioids either during (P = .003) or after (P < .001) TABI were more likely to be retained in treatment at 3 months.

Conclusion: The study shows TABI's acceptability and feasibility in a specialized addiction treatment setting; further research is needed for broader applicability.

Background: Drug-resistant tuberculosis (DR-TB) significantly increases the risk of depression, yet research on mental health in this population remains limited.

Aim: This meta-analysis aimed to evaluate the prevalence of depression among multidrug-resistant TB (MDR-TB) patients, emphasizing the necessity for integrated mental health care.

Methods: A systematic search across PubMed, Cochrane, EBSCOhost, and Google Scholar identified 536 articles, which were screened for eligibility after removing duplicates. Prevalence data were analyzed using R programming, with back-transformation applied to enhance accuracy. The methodological quality of the included studies was assessed with the JBI Critical Appraisal Checklist, and the study protocol is registered in PROSPERO (CRD42023449156).

Results: Ultimately, twelve studies involving 3,258 participants were included in the analysis. The pooled prevalence of depression among MDR-TB patients was found to be 54% (95% CI: 42%-65%). Although substantial heterogeneity was noted (I² = 72%; P < 0.01), excluding one study (Walker et al.) due to high Cook's distance revised the prevalence to 55% (95% CI: 43%-68%), with reduced heterogeneity (I² = 68%; P < 0.01). Subgroup analyses indicated minimal variability among studies using the Hamilton Depression Rating Scale (52%, 95% CI: 40%-64%) and substantial variability among those employing the Patient Health Questionnaire (54%, 95% CI: 30%-79%). Funnel plot analysis and Egger's test revealed no significant publication bias (P = 0.2105).

Conclusion: This study highlights a high prevalence of depression among MDR-TB patients, underscoring the urgent need for integrated mental health care strategies tailored for this vulnerable population. Further research is essential to refine these strategies effectively.

Background: Disaster mental health is a critical yet neglected aspect in India. Primary care physicians (PCPs) play a crucial role in mitigating mental health challenges following disasters. This study conducted a knowledge, attitude, and practice (KAP) survey among PCPs in Karnataka to assess their disaster mental health preparedness.

Methods: A cross-sectional online survey was conducted from February to May 2023 targeting PCPs across 29 districts of Karnataka in a convenient snowball sampling method. The questionnaire review included KAP questions on disaster mental healthcare. A total of 324 PCPs responded.

Results: Knowledge scores were moderate (mean: 7.05), attitudes were positive (mean: 9.15), and practices were poor (mean: 0.32). Significant correlations were found between clinical experience and knowledge/attitudes/practices (rho 0.358, P < 0.001; rho 0.147, P = 0.007; rho 0.232, P = 0.003).

Conclusion: There is a large gap between theoretical knowledge and practical preparedness in disaster mental health. Training programs and government initiatives are essential to improve preparedness among PCPs.

Background: The nature of aberrant salience in schizophrenia, whether it is a state or a trait phenomenon, remains unclear.

Aim: To assess and compare aberrant salience in patients with schizophrenia at different stages of the illness and to explore its association with symptom severity and medication use.

Methods: A total of 113 subjects were included, comprising 83 patients with schizophrenia divided into three groups: group A (acute drug-free symptomatic stage, n = 23), group B (chronic-medicated symptomatic stage, n = 30), and group C (chronic-medicated asymptomatic stage, n = 30). These were compared with a healthy control group (group D, n = 30). Participants were assessed using the Aberrant Salience Inventory (ASI) and clinical rating scales, including Psychotic Symptom Rating Scales, Scale for Assessment of Positive Symptoms, and Scale for Assessment of Negative Symptoms (SANS).

Results: Significant differences were observed across almost all domains of aberrant salience. The most notable differences were between the symptomatic groups (A, B) and the healthy controls (D). Subgroup analysis showed no significant differences between the acute (A) and chronic groups (B, C), but significant differences were found between the symptomatic (A, B) and asymptomatic (C) groups in several domains and in the total ASI score. A highly significant positive correlation was noted between the total ASI score and the symptom rating scales, except for SANS.

Conclusion: Aberrant salience is significantly elevated in patients with prominent positive symptoms, particularly delusions and hallucinations. It appears comparable to the general population in chronic remitted patients, suggesting that aberrant salience is state-dependent. Medication did not significantly influence aberrant salience as both medicated and nonmedicated symptomatic patients continued to exhibit it. However, medication may contribute to reducing aberrant salience by alleviating positive psychotic symptoms.