Indian Journal of Psychiatry最新文献

Background: Diamine oxidase (DAO) deficiency, a key marker of histamine intolerance (HIT), often mimics anxiety or panic disorders, leading to a misdiagnoses and delayed treatment.

Cases: We present five female patients (aged 25-54) with chronic, non-specific symptoms, including palpitations, nasal congestion, and gastrointestinal disturbances, initially attributed to the anxiety. Serum DAO levels below 10 IU/mL confirmed HIT in all cases. Treatment with a low-histamine diet and DAO supplementation significantly improved symptoms, highlighting the importance of considering HIT in such cases. One patient experienced recurrence after discontinuing treatment, emphasizing the need for long-term management. Genetic testing in one case revealed variants linked to reduced DAO activity, suggesting a potential genetic predisposition.

Conclusion: These findings underscore the importance of DAO level assessment in patients with unexplained symptoms and the role of multidisciplinary care in accurate diagnosis and management. Further studies are needed to refine diagnostic criteria and explore long-term strategies for HIT.

India carries one of the world's highest mental health treatment gaps. Despite the Mental Healthcare Act 2017 and national programme expansions, large proportions of people with common and severe mental disorders remain undiagnosed or untreated. The care cascade framework, originally applied in HIV and tuberculosis, provides a structured approach to identify points of attrition across seven stages: awareness, help-seeking, access, diagnosis, initiation of treatment, continuity of care, and recovery. Evidence from programme evaluations highlights major drop-offs at recognition, initiation, and long-term adherence. Task-sharing with non-specialist providers, digital platforms such as Tele-MANAS, strengthened District Mental Health Programme services, and integration through Health and Wellness Centres have improved reach but remain fragmented and uneven. Cascade-based indicators allow health systems to monitor performance at each stage and to prioritise interventions where the loss is greatest. Embedding this framework within national policy can enable more efficient resource allocation, reduce inequities, and promote recovery-oriented mental health services in India.

Background: Agitation in Alzheimer's disease (AD) severely affects patients and caregivers. Brexpiprazole, a serotonin-dopamine modulator, is the potential treatment; however, recent trials and variations in dosing have raised questions about its optimal efficacy and safety.

Aim: To evaluate the efficacy and safety of brexpiprazole in the treatment of agitation associated with AD, with a focus on dose-specific outcomes.

Methods: A systematic search was conducted in PubMed, Embase, and the Cochrane Library for Randomized Controlled Trials (RCT) comparing brexpiprazole with placebo in AD-related agitation. Primary efficacy outcomes included changes in the Cohen-Mansfield Agitation Inventory (CMAI) and Clinical Global Impression-Severity (CGI-S) scores. Safety outcomes encompassed treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), and mortality. Meta-analyses were performed using a random-effects model, with mean differences (MD) and odds ratios (OR) reported with 95% confidence intervals (CI).

Results: Four RCTs with 1,710 participants were included. Brexpiprazole 2 mg significantly reduced CMAI scores (MD: -5.618; 95% CI: -7.884, -3.351; P < 0.001) and CGI-S scores (MD: -0.513; 95% CI: -0.890, -0.135; P = 0.008) compared to placebo. Lower doses (0.5-1 mg) demonstrated limited efficacy. TEAEs were more frequent with brexpiprazole 2 mg (OR: 1.554; 95% CI: 1.045, 2.312; P = 0.030), while SAEs (OR: 1.389; P = 0.384) and mortality (OR: 2.189; P = 0.301) did not significantly differ from placebo.

Conclusion: Brexpiprazole 2 mg is effective in reducing agitation symptoms in AD with an acceptable safety profile.

Background: Smartphone addiction is an emerging public health issue worldwide, affecting individuals across age groups, including undergraduate medical (MBBS) students.

Aim: This systematic review and meta-analysis aimed to estimate the pooled prevalence of smartphone addiction among MBBS students in India and to explore variations based on the demographic, regional, and methodological factors.

Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, EBSCO, and Embase for studies published up to October 01, 2024, following a PROSPERO-registered protocol (CRD42024607941). Studies reporting the prevalence of smartphone addiction among MBBS students in India were included. Two reviewers independently screened studies, extracted data, and assessed quality using the joanna brings institute (JBI) critical appraisal checklist. Meta-analysis was performed using R version 4.4.2 (2024-10-31 ucrt). Single arcsine transformation with maximum likelihood estimator was used for pooled prevalence calculation. Subgroup analyses examined differences based on the geographic region, sampling method, academic year, and type of scale used. Meta-regression assessed the influence of potential moderators. Leave one out sensitivity analysis was conducted. Publication bias was evaluated using Doi plot and luis furuya- kanamori (LFK) index.

Results: Twenty-four studies were included in the analysis. The pooled prevalence of smartphone addiction among MBBS students was 60% (95% CI 45% to 73%; number of studies = 24), with high heterogeneity (I² = 99.4%, P < 0.001). The overall prevalence of smartphone addiction among undergraduate medical students (evaluated using screening instruments for smartphone addiction) in India is 60%. Although some subgroup differences (regarding region studied, sampling method used and batch of MBBS studied) were found to be statistically significant, it is important to interpret these findings with caution, as these differences may still be influenced by chance occurrences, random error, or underlying study-level biases.

Conclusion: The high prevalence of smartphone addiction among Indian MBBS students underscores the need for targeted awareness, preventive strategies, and support systems within medical institutions. Addressing this issue is critical to safeguard students' mental health and academic performance.

The Government of Tamil Nadu gazette the Minimum Standards of Care for Deaddiction Centres 2025, marking the significant step in regulating addiction treatment centers in the State. Issued under the Mental Healthcare Act (MHCA) 2017, this notification establishes a comprehensive framework addressing registration, admission procedures, types of treatment, infrastructure, and patient rights. The regulations emphasize the role of psychiatrists in decision-making, differentiate detoxification from rehabilitation, and mandate medical oversight in treatment facilities. They also introduce safeguards against human rights violations and prescribe minimum standards for staffing, documentation, and infrastructure. However, the provision to admit patients with severe dependence (leading to capacity impairment) with harm to self (due to excessive use), as a supported admission (under Section 89 of MHCA), remains contentious and liable to potential misuse. This is because persistent impairment of capacity, seen in severe mental illnesses such as schizophrenia, is not typically seen in patients with substance use disorders. The need for staff training and mechanisms to monitor outcomes and compliance is also not explicitly mentioned. In summary, these regulations provide a much-needed framework for the regulation of addiction treatment centers. The presence of periodic reviews, structured training programs, and robust oversight mechanisms would be critical for its appropriate implementation. This initiative also sets a precedent for other states to follow suit and optimize addiction treatment services across India.