Indian Journal of Psychiatry最新文献

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.

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.