Indian Journal of Psychiatry最新文献

Transcranial magnetic stimulation (TMS) has emerged as the pivotal non-invasive neuromodulation technique for the diagnosis and treatment of various neuropsychiatric disorders worldwide. In India, the adoption and evolution of TMS services have been marked by significant research contributions and clinical advancements over the past three decades. This review synthesizes the historical development, current applications, and prospects of TMS services in psychiatry in India, drawing on a comprehensive analysis of all relevant Indian publications. The growth of TMS research, institutional contributions, clinical protocols, and challenges in implementation is explored, while highlighting the potential for personalized and scalable TMS interventions in the Indian healthcare landscape.

Background: Given the overlap between gaming and gambling, and the need to demarcate between the two; it becomes important to understand the use of the term "gaming" in the Acts regulating gambling.

Aim: The current narrative review aimed to ascertain various contexts of the use of the term "gaming" across the different Acts regulating gambling in India.

Methods: We based our literature search on the online portal of India Code, including all online available publications. We conducted an electronic search in India Code for "gambling," "gaming," and "betting" to obtain all published Acts.

Results: We were able to identify a total of 26 relevant Acts. The term "gaming" or "game" was used in the title of eight Acts. The term "gaming" was used in the description of all but eight Acts. Also, six of the Acts, while targeted at gambling, did not include the term gambling and rather used the term gaming instead. In addition to the title and the definition/description, the term "gaming" has been used in various other sections of the Acts on gambling including the use of the phrase "common gaming house" and "instruments of gaming." Most of the Acts use the terms wagering and/or betting to describe "gaming." Most of the Acts make some reference to the games of skill and/or game of chance.

Conclusion: This review not only presents the specific themes of concern, but also highlight the heterogeneity in the existing regulatory framework for gambling across different regions of India. Such heterogeneity is likely to pose additional and unique challenges in context of the online gaming and gambling.

Background: Anxiety significantly affects students' academic performance and well-being, making it essential to examine their symptom manifestations and treatment-seeking behavior.

Aim: This study aims to assess the occurrence of anxiety symptoms among students of higher education in Guwahati City, Assam, and to examine their medical help-seeking behavior in relation to various demographic factors.

Materials and methods: Data were collected from 2715 randomly chosen students of 8 major government educational institutions using the standard Hamilton Anxiety Rating (HAM-A) Scale. Statistical tools like the Kruskal-Wallis H test, Median Test, Principal Component Analysis (PCA), and Chi-square test were used for analysis.

Results: Significant differences were found in the median scores of anxiety symptoms, as well as between the status of anxiety and the medical treatment preferences of students. Treatment-seeking behavior was influenced by age, education level, and family income, but not by gender, institution, or living status.

Conclusion: The findings highlight the need for tailored interventions to effectively manage anxiety and improve mental health support for higher education students.

Background: Suicidality in depression presents significant management challenges, with limited treatment options such as electroconvulsive therapy (ECT) and ketamine. Repetitive transcranial magnetic stimulation (rTMS) is an emerging intervention for such cases, particularly when ECT is contraindicated. This chart review examines the clinical outcomes of accelerated TMS (aTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) for suicidality in depression patients.

Cases: Six patients with depression and suicidality underwent aTMS targeting the left DLPFC between June 2024 to March 2025. Excitatory rTMS was administered using intermittent theta burst stimulation (iTBS) at 100%-120% of RMT. Treatment sessions were delivered over 6.17 ± 1.86 days, with a 60-min intersession interval to maximize cortical excitability. Symptom severity was assessed using the Columbia Suicide Severity Rating Scale (CSSRS) as the primary outcome measure and Hamilton Depression Rating Scale (HDRS). Significant reductions were observed in CSSRS scores (mean difference 11.87, 95% CI: 5.63, 18.0), corresponding to a 73.3% reduction in suicide severity. HDRS also improved significantly (mean difference 18.2, 95% CI: 13.50, 22.8), corresponding to a 73.1% reduction. All but one patient achieved a treatment response, and four patients met remission criteria. The interventions were well-tolerated, with no serious adverse effects.

Conclusion: This study provides preliminary evidence supporting the efficacy, safety, and rapid reduction in suicidality with left DLPFC aTMS in depression. Randomized controlled trials are needed to validate these results, optimize treatment protocols, and assess the durability of clinical benefits.

Background: Flexibility, or the ability to adapt to changing circumstances, is crucial for psychological health. Depression is often characterized by inflexibility in various domains.

Aim: This cross-sectional study aimed to assess, compare, and examine the correlations between cognitive, explanatory, coping, and belief flexibilities in individuals with major depression.

Materials and methods: A sample of 40 adult patients with major depressive disorder (MDD) was compared with 40 healthy matched controls using the Wisconsin Card Sorting Test, Attributional Style Questionnaire, Coping Flexibility Scale, and the Emotional variant of the Bias Against Disconfirmatory Evidence task.

Results: Results revealed that individuals with depression exhibited significant coping inflexibility. They also exhibited belief inflexibility when the stimuli were self-referent and negative. However, no cognitive inflexibility was observed. In the clinical group, cognitive flexibility correlated with both positive and negative belief flexibilities, while explanatory and coping flexibility showed no links. In controls, cognitive flexibility was related to negative belief flexibility, and explanatory flexibility was associated with positive belief flexibility. Multiple regression analyses further showed that cognitive flexibility significantly predicted both negative (β = -0.61, P < 0.001) and positive belief flexibility (β = -0.57, P < 0.001) in individuals with depression, suggesting a potential causal link.

Conclusion: These findings suggest that specific areas of flexibility are impaired in depression. Furthermore, different correlation patterns in both groups may have important clinical implications.

Background: Heart rate variability (HRV) is a measure of physiological function of the autonomic nervous system. HRV decreases immediately after alcohol consumption. In those with alcohol dependence, HRV is lower than in healthy individuals even after several days of abstinence.

Aim: The study aimed to investigate whether abstinence from alcohol had an association with changes in HRV.

Methods: An observational study conducted at the psychiatry unit of a tertiary care hospital. 100 patients of age 18-45 years fulfilling criteria for alcohol dependence syndrome were included along with 100 healthy age and gender matched controls. HRV indices (pNN50, SDNN, rMSSD, HFHRV, LFHRV, and LF/HF ratio) were compared, before and after 4 weeks of detoxification with de-addiction treatment as usual.

Results: At admission, compared to the controls, cases had significantly lower means for the HRV indices. Four weeks after detoxification, cases had significantly higher values of HRV indices. Craving scores correlated with changes in HRV indices. No association was observed with age of onset of drinking or dependence, family history, or choice of anti-craving medication.

Conclusion: HRV was reduced in cases of ADS; however, with detoxification and continued abstinence, it increased within a period of 4 weeks. Also, craving was associated with change in HRV indices. Thus, HRV is affected by alcohol use but it reverses with alcohol detoxification and abstinence. Hence, can be used as a reliable biomarker of abstinence as well as craving.