Indian Journal of Psychiatry最新文献

Background: Depression is a major public concern among older adults. However, limited studies have examined the association of depression and household air pollution (HAP). Therefore, this study examines the association between HAP due to unclean fuel use and depression among older adults in India.

Methods: Data from Longitudinal Aging Study of India (LASI), wave-1 (2017-18) were used (N = 50,206, ≥50 years). Depression measured by CIDI-SF (Composite International Diagnostic Interview-Short Form) was the outcome variable. Household unclean fuel use was considered as proxy of HAP. Bivariate analyses and multivariate logistic regression were used to fulfil the study objectives.

Results: The prevalence of depression was greater among unclean fuel users than clean fuel users (9.6% vs 6.6%). Results showed that household unclean fuel use was associated with higher odds of depression. The interaction analyses showed that females and rural residents were at higher risk of depression due to HAP exposure. Furthermore, household cooking conditions also played an important role in the association between HAP exposure and depression. Unclean fuel use indoors without ventilation and with traditional chullah/stove was associated with higher odds of depression among older adults.

Conclusion: The study concludes that exposure to HAP due to unclean fuel use should be considered as a potential risk factor of depression among older adults. Therefore, the study suggests an urgent need to create awareness about negative effects of unclean fuel use on mental health and promote clean fuel usage in households to ensure healthy aging.

Background: Chronic insomnia, affecting 15.9% of the population, is characterized by sustained hyperarousal and heightened somatic, cognitive, and cortical activity. Despite its prevalence, the precise impact of chronic insomnia on cognitive domains, particularly attention, working memory, and executive function, remains inadequately understood.

Aim: This study aims to systematically investigate the cognitive functioning of adults with chronic insomnia.

Methodology: A meticulously matched cohort of 80 participants, comprising 40 with chronic insomnia and 40 controls, participated in this cross-sectional study. The diagnosis followed strict criteria outlined in the International Classification of Sleep Disorders-3. Neuropsychological assessments, including the Digit Span Test, Stroop Test, and Trail Making Test, were employed to scrutinize attention, working memory, and executive function. Robust metrics, such as the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), supported the investigative approach.

Results: Analysis revealed notable deficits in backward digit span, digit symbol substitution test, and Stroop Test (cards B and C) among chronic insomnia subjects compared to non-insomniac counterparts. Trail Making Test B indicated prolonged completion times in the chronic insomnia cohort. Despite comparable levels of anxiety and depressive symptoms, the chronic insomnia group exhibited higher ISI and PSQI scores, indicating the severity of their sleep disturbances.

Conclusion: This cross-sectional analysis reveals cognitive deficits associated with chronic insomnia, specifically impacting attention, working memory, and executive function. Even with meticulous demographic controls, chronic insomnia leaves a discernible impact on cognitive functions. The study underscores the need for precise cognitive evaluations to reveal the latent impact of chronic insomnia, offering insights for targeted interventions.

Aim: This paper highlights the difficulties and lacunae in the Mental Health Care Act 2017 that hinder its implementation and use for the care and treatment of persons with mental illness in India.

Methods: An online nationwide survey, involving structured questions as well as open-ended questions, to elicit the level of implementation, experience in complying with the provisions of the Act, and level of satisfaction, of practicing psychiatrists was carried out. Responses were analyzed using appropriate statistics.

Results: 600 respondents answered the online questionnaire. A majority of psychiatrists were senior practitioners with over 10 years of experience. 92.5% respondents were dissatisfied with the MHCA, wherein 73.3% wanted it amended, and 19.2% asked for repeal. Procedural issues were deterrent for 66.5% from taking medically necessary or helpful decisions for patients. Non-implementation of the Act was a major finding. Major dissatisfaction was expressed regarding judicial over reach in admission and discharge procedures, inclusion of general hospital psychiatry units in the definition of mental health establishment, non-applicability of provisions like advance directive and nominated representative in Indian setting, and that all treatment should be covered under insurance.

Conclusion: The Act in its present form defies the spirit of its own objectives and is unimplementable. It needs major revisions.

Background: Persistent suicidal ideation, self-harm behaviors, and suicide attempts constitute suicidality and are consistent predictors for future suicides. Research on what protects individuals from harming themselves is equivocal. While factors like impulsivity could increase risk of suicide, research is needed on what stops people from acting out on self-harm thoughts/suicidal ideation.

Aim: To explore the help-seeking behaviors and other protective factors during periods of suicidality in individuals at risk of suicide.

Method: This study aimed to explore help-seeking behavior and other protective factors that prevent or delay self-harm and suicide attempts during suicidality in individuals at risk. We used a qualitative study design and interviewed 15 participants comprising at-risk individuals, caregivers, and mental health professionals (MHPs). We used thematic analysis for deriving themes.

Results: Themes in 'at-risk individuals' include mental state during suicidality, handling of oneself during suicidality, and seeking help from support systems. Themes from caregivers included handling of crises and the role of informal and formal support systems. Themes from MHPs included phenomenology of suicidality, handling of suicidality, help-seeking, and support systems.

Conclusion: At-risk individuals handle suicidality by either managing themselves on their own or seeking help from informal sources and formal health systems. Caregivers appear to be crucial stakeholders in help-seeking during self-harm. The involvement of caregivers - in discussion with the at-risk individual - should be a necessary component of suicide risk management. Suicide prevention policies at institutional, regional, and national levels should include strategies to prevent burnout and other occupational health issues in MHPs.

Background: Individuals experiencing alcohol dependence syndrome (ADS) may struggle with relapse due to various factors, even after receiving successful inpatient treatment. While motivation enhancement therapy (MET) and pharmacotherapy are commonly used interventions for ADS, incorporating task-centered casework (TCP) - a nondirective, goal-oriented, and time-limited approach - may yield promising outcomes.

Aim: This study examined the effects of adjunctive TCP in conjunction with pharmacotherapy and MET on frequently relapsing patients with ADS.

Materials and methods: This study utilized a case-control design to evaluate the efficacy of combined therapies (pharmacotherapy, MET, and TCP) on 60 male subjects with a diagnosis of ADS and multiple admissions in a tertiary deaddiction center. The participants were divided equally into experimental and control groups, with the experimental group receiving all three therapies and the control group only receiving pharmacotherapy and MET. Both groups maintained their pharmacotherapy regimens throughout the 2-month study period. Assessments were conducted at baseline and the end of the study using various measures, including social-demographic and clinical data, the SAD-Q, ACQ SF-R, SOCRATES-8A, CIWA-Ar, and WHOQOL-BREF Hindi version.

Results: The results of the study indicate that the experimental group exhibited a marked decrease in alcohol cravings, an increased willingness to make positive changes, and overall better treatment outcomes and quality of life compared to the control group. In patients with ADS who underwent treatment with MET, TCP, and pharmacotherapy, it was observed that cravings were a significant predictor of their quality of life and readiness to make changes.

Conclusions: TCP can be complemented with existing addiction therapies in the treatment of addiction because it has additional advantages in the form of nondirectiveness, goal orientation, time-limitedness, and collaboration between the therapist and the patient. ADS patients can benefit from this therapy by discovering their inert potential and identifying their shortcomings.

Background: There is a lack of comprehensive data sources on various rating instruments that have been developed, translated, and adapted in Indian context.

Aim: Accordinly, this review aimed to compile the available scales/questionnaires/instruments developed, adapted, and translated for use in India.

Methods: For this, the search engines like PUBMED, Google Scholar, MedKnow, and Science Direct were searched for scales that have been developed, translated, and adapted in Indian context or an Indian language. Only articles reporting a scale/questionnaire development/interview schedules from India or in an Indian language were included.

Results: Available data suggests that most of the instruments that have been translated in the Indian context have been done so in Hindi language. Very few instruments are available in other languages. The scales/instruments that are available in multiple languages include Mini International Neuropsychiatric Interview (MINI), General Health Questionnaire (GHQ), Patient Health Questionnaire (PHQ), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Edinburgh postnatal depression, Epworth sleepiness scale to evaluate daytime sleepiness, Columbia-Suicide Severity Rating Scale (C-SSRS), Recovery quality of life, World Health Organization Quality of Life-Bref version, Subjective happiness scale, Hospital Anxiety and Depression scale (HADS), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support (MSPSS), Internalized Stigma of Mental Illness (ISMI), COVID-19 stigma scale, Dyadic adjustment scale, Broad Autism Phenotype Questionnaire (BAPQ), Strength and Difficulties Questionnaire (SDQ), and Rosenzweig picture frustration study (Children's form). Overall, very few instruments have been developed in India.

Conclusion: To conclude, our review suggests that a limited number of scales have been developed in India and in terms of translation and adaptation, most of these have been done in Hindi only. Keeping these points in mind, there is a need to develop more psychometrically sound scales for research and routine clinical practice. Additionally, efforts must be made to translate and adapt scales available in different languages and subject the same to psychometric evaluations.

Background: Generalized anxiety disorder (GAD) affects up to 6% of the population, which if not detected early and adequately treated will continue as a hidden impairment resulting in disability.

Aim: The primary objective of the study is to assess the hair cortisol levels (HairF) in persons with GAD with and without alcohol dependence syndrome (ADS), and the secondary objective is to assess whether HairF can be used as a biomarker for assessment of GAD.

Materials and methods: This comparative study was done on 94 subjects (68 persons with GAD with or without ADS and 26 healthy controls) who were divided into three groups. Hamilton Anxiety Rating Scale (HAM-A) and Patient Health Questionnaire-4 (PHQ4) were also used to assess severity of anxiety symptoms. These scores were compared with HairF. Diagnostic accuracy of the HairF analysis test was done. Statistical analysis was done using SPSS version 20.

Results: The study found higher levels of HairF in persons with GAD (mean 189.4 ± 33.1) and GAD with ADS (164.2 ± 47.6) compared to healthy controls (mean 45.34 ± 40.7), which were statistically significant. Correlation of HAM-A and PHQ4 scores and HairF also showed positive correlation. The receiver operating characteristic curve suggested the best cutoff point at 88.4 pg/mg with a sensitivity of 98.5% and a specificity of 92.5%, clearly differentiating GAD from healthy controls.

Conclusion: HairF were found to be higher in patients with GAD irrespective of ADS as comorbidity. The study supports the possibility of the HairF as a possible biomarker to detect GAD and play a complementary role in a multidimensional approach for management of chronic stress and anxiety.