Indian Journal of Psychological Medicine最新文献

Background: As more accurate neuromodulation systems combining high-resolution electroencephalogram (EEG) and anatomical biomarkers develop, it is prudent to evaluate how refined and effective precision neuromodulation is compared to conventional techniques. Considering the growing incidence and the lack of studies outlining an optimal treatment approach, which often leads to a poorer prognosis, young-onset mania presents an ideal challenge for such a comparison.

Novelty: This study aims to be the first to directly compare precision and conventional neuromodulation in child and adolescent populations. It also seeks to study and compare, for the first time, changes in neuroimaging parameters caused by precision and conventional techniques. By correlating perturbation-induced changes in cortical inhibition paradigms and functional connectivity of cerebral circuits, we aim to introduce a more objective measure of therapeutic efficacy and response, as opposed to relying solely on subjective clinical scales. Furthermore, we aim to study, for the first time, task-based differential activation of brain areas in young-onset mania.

Methods: Participants would be randomly allocated to the intervention group 1 (G1) or the active control treatment group 2 (G2). Baseline assessments of both groups will include evaluations using clinical scales (Clinical Global Impression [CGI], Brief Psychiatric Rating Scale-Child [BPRS], Young Mania Rating Scale [YMRS], Barratt's Impulsivity Scale [BIS], and Affectivity Reactivity Index [ARI]), task-based and resting-state functional magnetic resonance imaging (rs-fMRI), and transcranial magnetic stimulation (TMS)-based cortical inhibition paradigms (cortical silent period [CSP], short interval intracortical inhibition [SICI], and long interval intracortical inhibition [LICI]). G1 would receive precision-based high-definition transcranial direct current stimulation (HD-tDCS) over the right ventromedial prefrontal cortex (VMPFC) daily for 10 days with 2 sessions spaced 4 h apart. G2 would receive conventional HD-tDCS over the right VMPFC daily for 10 days with sessions spaced 4 h apart. Participants would undergo reassessment at 2 weeks following the completion of 20 sessions, using scales, task-based and rs-fMRI, and cortical inhibition paradigms, as well as at 6 weeks.

Results: Data would be analyzed using the Statistical Package for the Social Sciences (SPSS) for outcome variables as defined for the study. The primary outcome variable would be the improvement in the severity of young-onset mania, as measured by YMRS and CGI scale scores, using precision over conventional HD-tDCS. The secondary outcome would be an improvement in functional connectivity, as measured by neuroimaging, and enhancement of cortical inhibition, as measured by cortical inhibition paradigms, in young-onset mania after receiving adjunctive precision over conventi

Background: Mental health integration into primary healthcare is pivotal in addressing mental, neurological, and substance use disorders in India. Community Health Officers (CHOs) and Mid-Level Health Providers (MLHPs) play a critical role in providing mental health services at the grassroots levels. Despite existing training modules, gaps persist in implementing sustained, practical training programs. This study evaluated the effectiveness of in-person mental health training combined with tele-mentoring for CHOs and MLHPs in Telangana and Tripura.

Methods: A mixed-method cross-sectional approach was employed. In-person training was delivered to 66 participants in Telangana and 396 in Tripura, covering theoretical modules, interactive sessions, and role plays. Pre- and post-assessments evaluated Knowledge (K), Attitude (A), and Practices (P). Instant Collaborative Video Consultations (CVCs) supported participants for three months post-training. Quantitative data were analyzed using paired t-tests, while thematic analysis was applied to qualitative data from focus group discussions and feedback.

Results: Statistically significant improvements in KAP scores were observed in both states (p < .01). The CVC model facilitated real-time support, with 91.84% of patients being first-time mental health service users. Substance use disorders (31.25%) and common mental disorders (27%) were the most identified conditions. Participants appreciated the interactive training design and recommended ongoing support.

Conclusions: The integration of in-person training with tele-mentoring effectively enhanced CHOs' and MLHPs' capacity to deliver mental health services. Scaling this model nationally, supported by continuous mentoring, could significantly improve community mental health outcomes.

Background: Considering the effects of environmental factors and genetic predispositions on mental health outcomes, the current work concentrated on the cannabinoid receptor 1 (CNR1) gene single-nucleotide polymorphism (SNP) rs1049353 as one of the primary genetic markers for cannabis-induced psychosis (CIP). By analyzing this SNP, the study contributes to the corpus of information to identify genetic traits that ultimately predict the response of an evolving disease following exposure to a particular substance after gene and environmental interaction and risk of a particular disease.

Methods: Grouped by CIP, cannabis use without psychosis, schizophrenia unlinked to cannabis use, and a healthy control group, a thorough investigation was conducted on a cohort of 120 patients at SCB Medical College, Cuttack. Standardized data collection within a cross-sectional study framework included socio-demographic profiles and genetic tests.

Results: Demographic analysis showed no significant differences in education, marital status, religion, occupation, housing, and family type between the groups. Genetic analysis done by real-time polymerase chain reaction (RT-PCR) to detect the prevalence of the CNR1 gene polymorphism among CIP patients was found to be 27.3% (95% CI: 12.1%-42.5%) for the heterogeneous allele and 72.7 % (95% CI: 57.5%-87.9%) for the homogenous allele. CIP patients showed a significant rise in homogenous allele expression in comparison to schizophrenia cases (p value: <.01; chi-square test).

Conclusions: The study found that a major contribution to the CIP risk in the CNR1 gene is an SNP, rs1049353. This result helps justify the need to include genetic elements in individual risk of developing a particular disease by linking gene and environmental interaction in cannabis related psychosis and accordingly the treatment plans and public health policy.

Background: Alcohol dependence occurs in about 9% of men in India. It is a major contributor to premature death and disability. Several clinical factors may play a role in the short-term outcomes of alcohol dependence.

Methods: A total of N = 122 male patients with alcohol dependence as per ICD-10 DCR criteria were recruited in this study. They were assessed on socio-demographic and clinical parameters such as severity of alcohol dependence (SADQ), motivation to quit alcohol (SOCRATES), and global cognition (MoCA) and frontal cognition (FAB). The patients were then followed up at 1- and 3-month time points using the timeline follow-back method of enquiry into their last 30 days of drinking.

Results: The mean age of the patients was about 40.6 (SD = 7.6) years. The duration of alcohol use was 18.56 years (SD = 7.22), and the average use was 14.14 units (SD = 8.62) per day. They had moderately severe dependence with SADQ scores of 25.13 (SD = 12.01). Two-thirds (n = 82) (67.2%) had low MoCA scores, and nearly one-fourth (n = 27) (22.1%) scored low on FAB. About 30% of patients relapsed at 1 month, and 50% relapsed by the end of 3 months. Earlier age at dependence (p = .012) was associated with relapse at 1 month. At 3 months, patients who were married (p = .040), had previous abstinence attempts (p = .003), and had higher MoCA scores (>26) (p = .042) were more likely to remain abstinent.

Conclusions: About 30% of patients with alcohol dependence relapse within 1 month, whereas 50% relapse by the end of 3 months. Early age at onset of dependence predicted relapse at 1 month, and married status, past abstinent attempts, and intact global cognition predicted abstinence at 3 months.

Purpose of the review: Chronic alcohol use is associated with various structural and functional changes in the brain. Retinal morphology assessed by optical coherence tomography (OCT) non-invasively detects alcohol related damage to the brain and can be a disease marker.

Collection and analysis of data: A systematic review of studies comparing retinal morphology using OCT, between alcohol use disorder (AUD) patients and healthy controls (HC) from PubMed, Scopus and Embase databases was performed (on 15/April/2025). Random effects meta-analyses were conducted for the thickness of retinal parameters, at both disc and macula: Retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), ganglion cell-inner plexiform layer (GCIPL), choroid thickness (CT), macular thickness (MT) and macular volume (MV). The Newcastle-Ottawa Scale was used for risk of bias (RoB) assessment. Publication bias, sensitivity analysis and certainty of evidence (CoE) was assessed using Doi plots, the leave-one-out method and the GRADE approach, respectively.

Results: Of the 2,416 records screened, eight studies (n = AUD = 6,276 eyes; HC = 2,695 eyes) were included in meta-analyses. They revealed significant thinning of the total (pooled SMD = -0.41; 95% CI = -0.68, -0.14; I ² = 75%; k = 6) and nasal (pooled SMD = -0.36; 95% CI = -0.58, -0.13; I ² = 56%; k = 6) peripapillary RNFL in AUD patients. Significantly lower average MT (pooled SMD = -0.62; 95% CI = -0.95, -0.29; I ² = 50%; k = 3) and macular GCIPL thickness (pooled SMD = -0.19; 95% CI = -0.33, -0.06; I ² = 67%; k = 3) were shown. CoE was 'moderate' for total peripapillary RNFL thinning, but was 'very low' for other outcomes, owing to heterogeneity and publication bias. RoB assessment showed one study with unsatisfactory quality.

Conclusions: Evidence for thinning of retinal layers, especially the peripapillary RNFL, as AUD disease-markers is promising, but preliminary. Our results align with the hypothesis that chronic alcohol consumption induces neurodegenerative changes in the retina and, therefore, the brain.