Indian Journal of Psychiatry最新文献

Background: Substance use disorders (SUDs), particularly alcohol dependence, represent the significant global public health challenge. Understanding the perspectives of service users and family members regarding addiction treatment is critical for improving care. Despite growing emphasis on patient-centered approaches, their insights remain underrepresented in shaping treatment programs.

Aim: To explore the treatment goals, expectations, and experiences of service users with alcohol dependence and their family members in a tertiary care hospital's substance use treatment ward.

Methods: This qualitative study was conducted in the substance use treatment ward of a tertiary care hospital. Using purposive sampling, 54 service users diagnosed with alcohol dependence and 53 family members participated in semi-structured, in-depth interviews. Participants shared their treatment goals, expectations, and recommendations for care improvement. Data were analyzed inductively using thematic analysis, with themes iteratively refined until saturation.

Results: Participants emphasized the need for comprehensive, stigma-free care. Service users sought sustained abstinence, physical health restoration, and societal reintegration post-discharge. Positive aspects included supportive staff, psychotherapy sessions, and effective relapse prevention strategies. A majority expressed high satisfaction (e.g., 70% endorsed "satisfied" or "very satisfied"), reflecting overall positive experiences. However, stigmatization and fragmented service delivery emerged as barriers. Family members echoed these views and stressed the role of family engagement in recovery.

Conclusion: This study reveals that personal, family, and systemic factors shape treatment experiences in alcohol dependence, with stigma, fragmented services, and limited family involvement as key barriers. Targeted strategies-integrated care, stigma reduction, and stronger family engagement-can enhance treatment quality and sustain recovery.

Herpes simplex encephalitis (HSE) typically presents with fever, seizures, and altered sensorium, but atypical presentations with predominant psychiatric symptoms can delay diagnosis and treatment. We report a case series of three patients, who initially exhibited psychotic symptoms, including hallucinations and mood disturbances, without classic neurological signs. Diagnosis was confirmed via cerebrospinal fluid analysis and MRI findings. Early antiviral therapy led to prompt recovery. This series highlights the importance of considering HSE in acute psychiatric presentations to prevent misdiagnosis and ensure timely intervention.

Background: High-definition transcranial direct current stimulation (HD-tDCS) modifies cortical excitability and its application over dorsolateral prefrontal cortex (DLPFC) has expanded to include addictive behaviors, given its capacity to alter core processes associated with addiction.

Aim: To assess the effect of excitatory HD-tDCS over left DLPFC on impulsivity, problem solving, executive functions, and overall severity in children and adolescents having behavioral addictions.

Methods: This hospital-based, double-blind, randomized, sham-controlled trial was registered prospectively in the Clinical Trial Registry of India (registration number -CTRI/2023/08/056081). 52 subjects aged 10-20 who scored ≥ 2 on Brief Screener for Substance and Behavioral Addictions were enrolled for the study. Participants were randomized into active (G1) and sham (G2) HD-tDCS groups and 20 sessions of HD-tDCS given, that is, twice daily for 10 days. Barratt Impulsiveness Scale, Problem Solving Inventory, Behavior Rating Inventory for Executive Functions, and Clinical Global Impression were used to assess outcomes at baseline and 2 weeks. tDCS side effects checklist was administered to monitor adverse events.

Result: Significant improvement was noted in both the groups across all outcome variables over time. HD-tDCS was well tolerated and was better in reducing impulsivity, problem solving, executive functions, and illness severity in the active group than in the sham group.

Conclusion: HD-tDCS has a substantial potential in improving the core processes involved in behavioral addictions adding a promising tool to the therapeutic options for young population.

This is the fourth and last article in the series on translation, adaptation, or development of a rating scale and its psychometric testing. The focus of this article is on criterion validity, construct validity, and factor analysis. Validity refers to whether the tool measures "what it purports to measure." Content validity, criterion validity, and construct validity are the different types of validity. Content validity was previously discussed in this series. Criterion validity assesses how a new scale correlates with a criterion or "gold standard." Depending on the time of administration of the "gold standard," this can be classified as concurrent or predictive validity. Pearson's correlation coefficient is the measure used to establish criterion validity for continuous variables, while phi coefficient is used for dichotomous ones. Construct validity assesses whether the new tool performs consistently with the theoretical concepts. This can be of two types: convergent and divergent validity, and is estimated using Pearson's correlation coefficient. Factor analysis (FA) is a multivariate technique that evaluates whether several variables are linearly related to a set of factors. It is also a method to assess construct validity. There are two methods of FA: exploratory and confirmatory FA; the steps of exploratory FA are discussed in detail here.

Background: Adolescents' sleep problems are commonly assessed by parents' interview.

Aim: To translate self-reported Children's Report of Sleep Patterns (CRSP) questionnaire in Hindi language (CRSP-H) and assess sleep pattern of adolescents.

Methods: CRSP questionnaire was translated in Hindi language following standard guideline. Translated CRSP-H was used for adolescents (11-18 years) of 7^th-12^th grade to assess their sleep pattern in term of sleep duration, Sleep Hygiene Indices (Caffeine Index, Activities Hour Before Bed index, Sleep Location Index, and Electronics Use at Sleep Onset Index), Sleep Disturbance Scores (Bedtime Fear/Worries Scale, Restless Legs Scale, Parasomnias Scale, and Insomnia Scale), and Sleep Patterns.

Results: Participants included 231 children (boys 55%; age 14.1 ± 1.6 years; class VII/VIII/IX/X/XI/XII 17.8%, 20.8%, 29.4%, 13.4%, 13.8%, and 4.8%, respectively; time taken 20.8 ± 7.2 min). Sleep duration on weekdays and weekends were 7.4 ± 1.2 and 9.0 ± 1.5 hours, respectively. 138 (67.6%) participants were good sleepers. Sleep Disturbance Scores were worse in poor sleepers. Senior grade students had shorter sleep on weekdays (P = 0.04) and weekends (P = 0.04). Bedtime for 57.1% was between 9 and 11 pm on weekdays and 61% after 11 pm on weekends. Poor sleepers had higher (P < 0.01) Electronic Use at Sleep Onset, Bedtime Fears, Restless Leg Syndrome Symptoms, and Insomnia in comparison to good sleepers. Poor sleepers had significantly higher (P < 0.01) sleepiness and bed wetting scores (P = 0.02).

Conclusion: Adolescents sleep for 7.4 hours on weekdays and 9 hours on weekends respectively. Higher classes and higher Sleep Disturbance Scores are associated with reduced sleep duration.

Background: Google Trends (GT) offers the novel approach for real-time monitoring of pregabalin-related online interest.

Aim: We examined whether the online interest in pregabalin captured by GT could approximate temporal trends and correlate with cross-national and state-level patterns of pregabalin consumption globally and in India.

Methods: Relative Search Volume (RSV) for "pregabalin" was retrieved from GT for global and Indian data (2008-2018). Consumption data were sourced from the IQVIA-MIDAS database and expressed as defined daily doses per 10,000 inhabitants per day (DDD/TID). For India, in the absence of state-level pregabalin consumption data, prevalence of opioid and sedative use was used as proxy indicators. Temporal trends were analyzed using Locally Weighted Scatterplot Smoothing, changepoint analysis, and cross-correlation function (CCF) with lagged regression. Pearson's correlation assessed cross-sectional associations between RSV and consumption data across 42 countries (2018) and 32 Indian states (2019).

Results: Online interest in pregabalin increased significantly over time globally (F = 202.28, P < 0.0001). CCF analysis showed strongest association at lag 0 (XCF = 0.98, P < .0001), indicating that online search interest and actual consumption occurred concurrently in the same year. RSV and pregabalin consumption were modestly correlated across countries (r = 0.44, P = 0.003). In India, state-level RSV moderately correlated with opioid (r = 0.44, P = 0.01) and sedative (r = 0.37, P = 0.04) use.

Conclusion: GT has a potential role in monitoring online interest related to pregabalin, which may serve as an indirect indicator of public engagement or awareness.

Early intervention in psychosis (EIP) has long been recognized as the critical determinant of long-term outcomes, yet in India, it remains largely absent from routine psychiatric care. This viewpoint reflects on two decades of experience at Schizophrenia Research Foundations (SCARF's) First Episode Psychosis (FEP) program in Chennai, offering grounded insights into how early intervention can be adapted to low-resource contexts without reliance on complex infrastructure. Drawing from lessons shaped in real time: through embedded services, hybrid follow-up models, and family-centered approaches, it argues that meaningful care can begin not only at the earliest signs of illness, but also at the point individuals first seek help. The paper challenges the assumption that specialist-heavy models are the only path to success, proposing instead a simple, responsive, and scalable model rooted in contextual realities. In doing so, it calls for a shift in how early psychosis is understood, engaged, and supported across India.

Background: Valproic acid (VPA) is the medication prescribed for the treatment of bipolar disorder, epilepsy, and migraine. It is reported that the VPA treatment leads to biotin deficiency due to the low serum biotinidase activity. Alopecia or hair loss is another common side effect of valproate administration.

Aim: The study aims to investigate hair loss complaint in people, who are on Valproate and find the association between valproate levels, serum biotinidase activity and hair loss in persons treated with valproate.

Methods: This two years cross sectional comparative study involving 150 participants was performed at department of Psychiatry of a tertiary care teaching hospital. The study group had 75 persons taking Valproate compared with 75 persons in the control group. Blood samples were collected for estimation of serum VPA levels and serum biotinidase activity. Quantification of alopecia biomarker Interleukin (IL)-2 was estimated. Data was analyzed by using student T test, Pearson's correlation, and Mann Whitney U test.

Results: The study group comprised of 40 males and 35 females with a mean age of 42.04 (±12.85) years. The control group had 39 males and 36 females with a mean age of 38.38 (±14.42) years. Hair loss was reported in 18 (24%) persons of study cohort compared to 2 (2.66%) among the control group. There was a statistically significant difference between biotinidase levels across the participants with hair loss complaint and those without hair loss complaint. (Mean rank of participants with hair loss complaint = 43.30, mean rank of participants without hair loss complaint = 80.45, U = 656.000, P ≤ 0.001). There was a statistically significant difference between the distribution of IL2 across the study and control groups. (Mean rank of study group = 57.73, mean rank of control group = 83.27, U = 3,395.00, P = 0.025).

Conclusion: It can be concluded that there is an association between Valproate levels, biotinidase activity and hair loss.