Indian Journal of Psychological Medicine最新文献

Background: Substance use is a serious public health concern and young adults in India often use multiple substances, often together. There is a dearth of research examining this and its neuropsychological consequences. Polysubstance use (PSU) usually indicates higher chances of dependence and negative outcomes. This study aims to describe the patterns of PSU and associated executive function profiles in a sample of young adults in India.

Methods: Fifty-four participants aged 18-25 years filled out a self-report questionnaire on PSU, for lifetime and current use of seven classes of substances. Thirty-four participants also performed four executive functions (Flexibility, Inhibition, Working Memory, and Planning). A descriptive analysis was used to identify patterns of PSU and one-way analysis of variance (ANOVA) was conducted to compare the executive functions between three groups of substance users with nonusers.

Results: Three patterns of PSU were identified in our sample: simultaneous (16.3%), concurrent (37.2%), and mixed (46.5%) patterns of use. Simultaneous and concurrent users reported the most commonly used substance combinations (alcohol/nicotine/cannabis). Performance on executive function tasks was compared among the different groups of substance users and nonusers. Executive function assessments revealed deficits in simultaneous users for inhibition (most errors) and planning (most number of moves) compared to other groups. Concurrent users had the lowest accuracy for the two-back visual working memory.

Conclusions: The findings of this small sample study suggest executive function deficits are more common in simultaneous users and underscore the need for more research to examine the synergistic effects of substances on cognition and executive functions.

Background: Premature ejaculation (PE) is one of the most prevalent male sexual dysfunctions globally, with prevalence estimates ranging from 5% to 40%. Recent frameworks classify PE into clinical subtypes based on chronicity, situational factors, and clinical characteristics, including lifelong, acquired, natural variable, and premature-like ejaculatory dysfunction (PLED). Despite its psychological and relational impacts, research on these subtypes, particularly in the Indian context, remains limited, underscoring the need for further exploration to inform tailored interventions.

Methods: This cross-sectional study assessed heterosexual men with PE at a tertiary center in North India. Individuals with significant psychiatric/medical comorbidities were excluded from the sample. A comprehensive evaluation of patients was done, including physical examination, hormonal/metabolic screenings, and assessments using validated tools for sexual dysfunction, psychiatric symptoms, and quality of life.

Results: A total of 102 patients were enrolled in the study. Pairwise comparisons indicated significant differences in age of onset between lifelong premature ejaculation (LPE) and PLED (P = .001), as well as between LPE and acquired premature ejaculation (APE) (P < .001). APE was significantly correlated with tobacco dependence (P = .009). Patients with LPE generally scored lower across various domains of the SF-36 Health Questionnaire, indicating more significant functional impairment.

Conclusion: APE emerged as the predominant subtype in the sample, followed by LPE-associated with a younger age-and PLED.

Background: Individuals with bipolar disorder (BD) experience considerable difficulty in functioning during remission as well. The actual lived experience of individuals with BD with respect to their functioning is not understood in the cultural context.

Methods: A qualitative approach in the form of interviews was taken from 11 participants who were diagnosed with BD in remission from a tertiary care hospital. The interviews were audio recorded and coded. Thematic analysis was carried out using a grounded theory approach to bring out relevant themes surrounding their inter-episodic functional limitations.

Results: The thematic analysis resulted in nine themes associated with the functioning, namely illness issues, treatment as an antidote, impact on self, relationship issues, coping strategies, disturbed cognitive functioning, stigma, occupational consequences, and dubious future.

Conclusions: The qualitative interview analysis provides a comprehensive picture of the experiences undergone by patients with BD. The themes and the sub-themes that came up in the analysis are reflective of the experiences of these individuals. The findings of the study can be utilized in planning effective interventions for remitted patients in the future so that functional limitations can be effectively addressed.

Screening for a disease typically results in earlier diagnosis and hence longer life lived with the disease. Earlier diagnosis permits earlier intervention, which is good if it improves functioning and quality of life from an earlier time point, and if it improves the course and outcome of the disease. However, for diseases that are benign, those that are relentlessly progressive, and those that arise late in life, earlier diagnosis and earlier intervention may not meaningfully change course and outcome. In such situations, the early detection and longer life lived with the disease can incorrectly suggest that the screening and early intervention prolonged survival. Expressed otherwise, longer survival may merely be an artifact of starting measurement earlier. This artifact is known as lead time bias. Lead time bias has long been recognized for many medical conditions, including cancers. In psychiatry, lead time bias is clearly associated with survival in dementia, and has recently been investigated in the context of duration of untreated psychosis and outcome domains in schizophrenia. It is important to know about lead time bias because it may play an unrecognized role in shaping health policy and clinical practice.

Background: Children with autism spectrum disorder (ASD) exhibit atypical responses to sensory stimuli. These sensory and perceptual issues persist as hyper-, hypo-, or atypical sensory reactivity that impacts their daily activities. The present protocol describes a method for developing a locally relevant and simple instrument for identifying and estimating the severity of sensory reactivity in children with ASD.

Novelty: Employing a consultative approach, the authors aim to develop and validate an Indian instrument to assess sensory reactivity in children with ASD.

Objectives: To gather insights from parents and experts about sensory reactivity patterns in children with ASD and to use this information to create and validate a culturally relevant tool for measuring the severity of sensory reactivity in these children.

Methods: This study will be conducted in two phases following an exploratory sequential mixed-method design. In the first phase, data will be collected through in-depth interviews of parents of children with ASD and focused group discussions with the experts. The collected data will be used to identify different themes and domains related to sensory reactivity. A questionnaire will be developed based on their inputs. In the second phase, the instrument will be analyzed further using exploratory factor analysis to obtain the factor structure and confirmatory factor analysis to test the factor structure of the developed instrument.

Expected outcome: A simple, reliable, and validated severity instrument will be developed for children with ASD and made accessible to all for convenient use.

Background: Many laws and acts related to mental health play a vital role in delivery of mental health services for persons with mental illness (PMI). In India, the Mental Health Act of 1987 (MHA, 1987) was replaced with the Mental Healthcare Act, 2017 (MHCA, 2017). However, there were numerous barriers and challenges in the proper implementation of the Act, and there is a paucity of research on the extent of implementation of the new Act. This study assessed the admission patterns of PMI admitted during the transition phase from MHA, 1987 to MHCA, 2017.

Methods: A retrospective chart review was done on admissions through the Hon'ble Magistrate's orders and mentally ill prisoners at a tertiary care psychiatric hospital in first four years (2018-2022) after MHCA enactment. Details regarding the admission, legal variables, and clinical variables were taken from case records.

Results: Our study included 354 patients, including 222 (62.7%) admissions through the Hon'ble Magistrate's orders and 132 (37.3%) mentally ill prisoners. Paranoid schizophrenia (n = 162, 52.9%) was the most common diagnosis and modified electroconvulsive therapy was given to 36% (n = 120) of patients. Total 115 (52%) patients were admitted under MHA, 1987, and 38 (17%) were admitted under MHCA, 2017, and no Act was mentioned in the case of 68 patients (30.6%).

Conclusions: This study highlights the extent of change in admissions of PMI after MHCA, 2017 enactment and sheds light on probable barriers for delay in the proper implementation of the Act. Our study emphasized the need for awareness about MHCA for all stakeholders as adherence to the proper procedure is necessary while admitting patients in closed wards and prison wards of the psychiatric facility.