Indian Journal of Psychiatry最新文献

This article is the third in a series of learning resources on translation/adaptation of a scale, new scale development and testing its psychometric properties. This paper deals with the process of domain identification and item generation for a new scale and how to perform content validity (CV). During the scale development, the domain of interest/construct must be well-articulated and decided a priori. Item generation should be informed by deductive as well as inductive methods to capture a comprehensive item pool. Items for a scale should be simple, unambiguous, accounting for the experiences of the target population and follow a normal conversation. CV assesses the relevance and representativeness of a scale's items. It is assessed through face validity (involving the target population), content validity ratio (CVR), content validity index (item and scale level), and interrater agreement (percent agreement, Cohen's kappa, and Fleiss' generalized kappa) by involving experts. In this paper, we provide insights and practical guidance on how to generate items for a scale and perform content validity checks. We have provided, and practical guide for conducting analyses and interpreting results on SPSS and MS Excel for analysis.

Background: The role of sex chromosomes in transmission of schizophrenia may be revealed by studies of phenotypic characteristics.

Aim: To explore variations in dermatoglyphic parameters between probands with schizophrenia and their respective affected gender-matched parents, with unaffected controls.

Methods: The difference of the absolute finger ridge counts (AFRC) and occurrence of identical finger patterns between the male probands and their affected fathers (n = 12) was compared with that of female probands and their affected mothers (n = 15). Similar comparisons were done between patients and unaffected child-parent pairs.

Results: The mean AFRC difference between right middle fingers of female probands and their affected mothers was less (3.47) than the mean (10.5) of normal controls, and interestingly, it also was less than that of between male probands and their affected fathers (mean-7.45). The mean of AFRC difference between the right thumbs of female probands and their affected mothers (6.07) was lower than that of normal controls (10.2). Additionally, identical patterns were more between the respective right index and middle fingers of female probands and their affected mothers compared to normal controls. The left little fingers of male probands and their affected fathers had more identical patterns than their female controls.

Conclusions: The closeness of dermatoglyphic traits between female probands and their affected mothers prompts us to speculate inheritance of schizophrenic traits more through X-chromosomes.

Background: Illicit substance use is a major social issue affecting youth worldwide. Early identification of its drivers is essential to implement effective interventions and protect youth from its harmful consequences.

Aim: To examine patterns and risk factors of illicit substance use among young adults and explore perceptions of students and teachers on the issue.

Methods: An explanatory sequential mixed-method study was conducted over 2 years, among 2,170-degree college students in Udupi taluk. A cross-sectional study identified risk factors, followed by four focused group discussions with students and teachers to explore perceptions. Tobacco and alcohol use was excluded. Binomial logistic regression analysed the factors associated with substance use, while deductive thematic analysis was applied to qualitative data; findings were integrated through data triangulation.

Results: 1.8% participants reported lifetime illicit substance use. The mean initiation age was 19 (SD 1.4) years, with cannabis used by 74.3%. Substance use was associated with male gender, lack of parental awareness of children's whereabouts, poor knowledge, and negative attitudes. Drivers included curiosity, pleasure-seeking, festivities, stress management, relationship breakups, peer pressure, career stress, pre-sport use, and social media influence.

Conclusions: Illicit substance use among young adults arises from a complex interplay of factors. The findings highlight the need for screening and brief intervention, along with educational interventions to improve awareness among adolescents and teachers to prevent substance use.

Background: Cognitive deficits significantly contribute to the disability related to schizophrenia.

Aim: We aim to evaluate the efficacy of high-frequency rTMS intervention in the improvement of cognitive symptoms in schizophrenia.

Methods: One-hundred patients of predominantly negative schizophrenia having cognitive deficits were enrolled for this randomized, sham controlled, double-blind trial. Active group received 20 sessions of rTMS at 20 Hz frequency and 100% motor threshold with total 2000 pulses over 4 weeks. Those receiving 5 consecutive rTMS sessions were included in primary and safety analysis. The trial protocol was registered with the Clinical Trials Registry - India (CTRI/2019/05/019099). An intention to treat (ITT) analysis was conducted for the intervention.

Results: A total of 497 patients were screened, with 100 randomized to active (n = 50) and sham (n = 50) rTMS groups. Baseline demographic and clinical characteristics were comparable between groups. The mean total scores and dysfunction ratings on the PGI Memory Scale, as well as performance on other cognitive measures, did not differ significantly between active and sham groups at any assessment point. Within the active rTMS group, significant improvements over time were observed in total dysfunction rating (P = 0.018), delayed recall (P = 0.042), immediate recall (P = 0.039), and verbal retention of dissimilar pairs (P = 0.014). A significant between-group difference was found only for remote memory change at 1-month follow-up (P = 0.016). Two adverse events were reported in the active group (one partial seizure, one case of aggravated psychosis), leading to discontinuation of intervention; no serious adverse events occurred in the sham group.

Conclusions: High-frequency rTMS resulted in modest improvement in specific cognitive measures, most notably remote memory in the active group at 1-month follow-up, but did not demonstrate significant overall group differences in cognitive outcomes compared to sham. It builds ground for further research assessing for delayed effects using neuronavigational methods.

Background: Affiliate stigma (AS) is self-stigma in caregivers, having three salient components: affective, behavioral, and cognitive. High caregiver AS causes concealment of mental illness and has negative consequences. Appropriate intervention for AS can offset such consequences.

Aim: To develop a pragmatic, affordable, and tentatively effective mental health intervention that targets AS.

Methods: We formulated Intervention for Caregiver Affiliate stigma REduction (i-CARE) after the thorough literature review, mental health expert and caregiver feedback (for face validation), and a pilot study (for feasibility and preliminary effectiveness). Throughout, the focus was on simplicity (single session of 25 min), feasibility, and applicability across different settings (outpatient, inpatient, online) and modalities (face-to-face/direct intervention, video consultation/remote intervention) suitable for the North Indian cultural context. It incorporated anti-stigma components of psychoeducational and contact-based intervention. The study was registered at CTRI (2022/01/039333).

Results: i-CARE took about 4 months to develop. Expert suggestions, such as issues of medication adherence, functional recovery, and most importantly, an individualized session of doubt clarification, were included. The caregivers assessed the clarity, comprehension, and usefulness of the intervention. The final components included introductory interaction, multimedia-based audio-visual content, printed IEC material, and a one-to-one clarification session. We used lived caregiving experience through audio-visual content to target contact-based anti-stigma approaches, psychoeducational approaches through multimedia and flyers, and personalized sessions for individualized approaches. Pilot testing of i-CARE suggested its feasibility in administration and effectiveness in the immediate post intervention period.

Conclusion: We developed and validated i-CARE through an iterative process, keeping pragmatics and cultural contextuality in mind. We plan to test its efficacy in a robustly designed study.

Background: Mental illness, often linked to ignorance and superstitions, significantly impacts women's mental health, particularly during pregnancy-marked by significant physical, emotional, and psychological changes. Prenatal mental health screening face challenges like stigma and lack of standardized protocols, while family support is essential reducing stress and enhancing well-being.

Aim: To assess knowledge, attitude and help seeking behaviors towards mental ailments among pregnant women and their families visiting primary health centers (PHCs).

Methods: A cross-sectional study conducted at a PHC during antenatal checkup days over 1 month recruiting pregnant women and their family members aged ≥18 years. A total of 230 participants were recruited. Data were collected using a semi-structured questionnaire and validated scales: Mental Health Knowledge Schedule (MAKS), Community Attitudes towards Mental Illness (CAMI-12 item) and Mental Help Seeking Attitudes Scale (MHSAS). Descriptive statistics, Chi-square test, Student's t-test, one-way ANOVA, Pearson correlation, and linear regression were used. A P value < 0.05 was considered statistically significant.

Results: Most participants lacked awareness of mental illness during pregnancy and childbirth. Higher education levels among participants correlated with better mental health knowledge. Participants with greater knowledge and positive attitudes demonstrated increased help-seeking behaviors. Positive correlations were observed between mental health knowledge, favorable attitudes, and help-seeking behaviors.

Conclusion: Poor knowledge and unfavorable attitude toward mental illness impact help seeking behaviour, among pregnant women and their families, compromising maternal and child health. Intervention to enhance knowledge, and promoting perinatal mental health services are essential to address these gaps.