Indian Journal of Psychological Medicine最新文献

Background: This study evaluated intramuscular (IM) ketamine's efficacy and safety for rapid suicidal ideation reduction, addressing the critical need for fast-acting interventions in resource-limited settings where intravenous (IV) options are impractical.

Methods: We conducted a pre-post-interventional study of IM ketamine (0.5 mg/kg) over one year after approval of the institutional ethics committee. Adult patients with suicidal ideation, as measured by the six-point Montgomery-Åsberg Depression Rating Scale-Suicidal Ideation (MADRS-SI), were included if their MADRS-SI score was >4. Post-injection monitoring of suicidal ideation and adverse effects (A/E) was done after two hours and on Days 1, 3, 7, 14, 21, and 28. A repeat injection of the same dose was given only if the MADRS-SI score became > 4 again. The paired-T-test and repeated-measure ANOVA test were used for statistical analysis.

Results: Thirty-eight patients (mean age: 36.3 years) participated, with 66% diagnosed with major depressive disorder and a mean MADRS-SI score of 5.31. At two hours post-injection, the MADRS-SI score decreased by 4.13 points (78% reduction), with 76% (N = 29) of patients reporting no suicidal ideation (score 0-1). Of the 28 patients who completed a one-month follow-up, 89% (N = 25) maintained a reduction in suicidal ideation (mean reduction: 4.75 points). A total of 64% (N = 16) required only one injection, while 36% required multiple injections. Three patients did not recover even after six trials of ketamine. Among 21 patients who completed six months of follow-up, 8 (28%) patients had relapsed. A/E was reported in 87% of patients, with dizziness and sedation being the most common (57%). No serious or life-threatening adverse effects were noted.

Conclusions: IM ketamine (0.5 mg/kg) is effective and safe for the rapid reduction of suicidal ideation.

Background: Childhood trauma encompassing abuse, neglect, and household dysfunction is known to have enduring consequences on mental health, increasing susceptibility to depression, anxiety, and PTSD (post-traumatic stress disorder) across the lifespan. Despite the rising focus on mental health in higher education, research on the prevalence and impact of childhood trauma within Indian undergraduate populations remains limited. This study examines the prevalence of childhood trauma and its association with mental health outcomes in undergraduates, framed within a lifespan developmental perspective.

Methods: We conducted a cross-sectional study involving 410 undergraduate students (74.6% female; mean age = 20.57 years). Participants completed validated instruments: The Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI-21), PTSD Checklist for DSM-5 (PCL-5), and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Descriptive statistics, Pearson's correlations, and multiple linear regression analyses were employed to assess the relationships between childhood trauma subtypes and mental health outcomes.

Results: Emotional abuse (r = 0.507, p < .01) and physical abuse (r = 0.517, p < .05) demonstrated the strongest associations with depression, anxiety, and PTSD symptoms. Emotional neglect significantly predicted depressive symptoms (β = 0.231, p = .002). Female students reported substantially higher PTSD scores compared to males (p < .05), reflecting gendered differences in trauma responses. Although minimization/denial of trauma showed negative correlations with mental health symptoms, these associations were not statistically significant, suggesting a possible role of avoidance-based coping.

Conclusions: This study reveals a robust relationship between childhood trauma and mental health challenges among undergraduates, with emotional abuse, physical abuse, and emotional neglect emerging as key predictors of psychological distress. The findings highlight the urgent need for trauma-informed, gender-sensitive mental health interventions within academic institutions. Early screening and culturally tailored support services could play a pivotal role in mitigating the long-term impacts of adverse childhood experiences during the critical life phase of emerging adulthood.

Background: Dyslexia, a neurodevelopmental disorder characterized by difficulties in word recognition and decoding, remains underexplored in non-Western orthographies such as Persian. To estimate the prevalence of dyslexia and examine the relationship between decoding and reading comprehension among Persian-speaking elementary students.

Methods: A cross-sectional study was conducted among 1,400 students (Grades 2-5) using a multistage stratified-cluster sampling design. Dyslexia was identified using the nonword reading subtest of a standardized reading and dyslexia test, with intellectual functioning assessed via the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Survey-weighted logistic and linear regression models were used to analyze associations and interactions, with a Bonferroni correction (p < .0083) applied for multiple comparisons. Confidence intervals (CI) and odds ratios (OR) are reported.

Results: The weighted prevalence of dyslexia was 10.40% (95% CI: 9.00-12.05), with higher rates in boys (14.50%, 95% CI: 12.42-16.92, OR: 2.66, 95% CI: 1.90-3.71, p < .001) than girls (6.01%, 95% CI: 4.61-7.80) and in private versus public schools (6.40% vs. 12.08%, OR: 0.50, 95% CI: 0.33-0.75, p = .002). Word reading and comprehension were significant protective factors (p < .001), while phonological awareness was non-significant in adjusted models. Decoding strongly predicted comprehension in typical readers, but this association was significantly weaker in dyslexic students (p = .006).

Conclusions: Dyslexia affects approximately one in 10 Persian-speaking students, with variations influenced by gender, school type, and reading skills. Comprehensive screening and interventions targeting decoding and comprehension are critical, particularly in public schools.

Background: Common mental disorders (CMDs) in older adults contribute to considerable disease burden and are associated with significant multimorbidity. With the increase in population ageing, the concerns related to multimorbidity are likely to increase. Cognitive-behavioural therapy (CBT) is an evidence-based approach for CMDs. More recently, transdiagnostic approaches to address shared mechanisms across disorders have been studied. Novelty: Despite a considerable body of literature on psychological interventions in higher-income countries, there is a notable lack of empirical studies examining the efficacy of transdiagnostic CBT (tCBT) in CMDs and older adults in India. In this study, we propose to test the effectiveness of a tCBT adapted for older adults, involving stakeholders.

Objectives: To examine the efficacy of a tCBT for older adults with CMDs.

Methods: A two-group parallel-arm randomised controlled design will be adopted to examine the efficacy of tCBT in older adults with CMDs. A total of 120 older adults (N = 60; intervention and control arm, respectively), meeting criteria for CMDs and scoring above the cut-off on Patient Health Questionnaire-9 and/or GAD-7, consenting for participation, will be randomised to receive either tCBT or treatment as usual plus psychoeducation (TAU + psychoeducation). The primary outcome (mood) will be measured using HAM-A and HAM-D. Secondary outcomes include sleep disturbances, repetitive negative thinking (RNT), metabolic effects, and quality of life. Participants will be assessed at baseline, post-intervention, and 3-month follow-up. The intervention will be adapted to older adults in India, based on a needs analysis with stakeholders (patients, caregivers, and experts).

Expected outcomes: There is a dearth of systematic studies in India on psychotherapy in older adults, particularly those that target multimorbidity and transdiagnostic processes such as sleep and RNT. This psychotherapy trial will provide important empirical data on the efficacy of evidence-based tCBT in older adults with CMDs.