Industrial Psychiatry Journal最新文献

Background: Suicidality is a critical concern among patients recovering from intensive care unit (ICU) admissions due to their heightened vulnerability to psychological stressors and psychiatric illness. Quantitative studies specifically examining how these ICU-related stressors correlate with suicidal ideation remain limited, indicating a critical need for further research in this area.

Aim: This study explores the direct and indirect factors associated with suicidality and predictors of suicidality among patients discharged from the ICU.

Materials and methods: This cross-sectional observational study was conducted at a tertiary care hospital in Uttar Pradesh, India. 315 patients were screened, and 250 adult participants were selected using convenience sampling. These participants were discharged from the medical ICU and recruited during follow-up visits to the psychiatry outpatient department between July 2021 and July 2022. Inclusion criteria encompassed individuals aged 18 years or above who had been discharged within 1 month of ICU stay and provided informed consent. Demographic and clinical variables were collected, including psychiatric diagnoses according to ICD-10 criteria. Suicidality was broadly defined to include suicidal ideation, planning, and attempts. Statistical analyses included Chi-square tests, Structural Equation Modeling (SEM) for direct and indirect associations, and machine learning-based Decision Tree Classification for prediction analysis.

Results: The majority of participants were aged >30 years (83.9%), female (56.4%), and from urban areas (52.8%). Significant associations with suicidality were observed for family history of mental illness (P = 0.004), substance use (P < 0.001), medical comorbidities (P < 0.001), and co-occurring psychiatric illnesses along with depression (P < 0.001). SEM revealed that severe depression, co-occurring psychiatric illnesses, substance use, and extended ICU stays (>7 days) directly influenced suicidality, with past psychiatric history exerting an indirect effect through the severity of depression. Decision tree analysis ranked "more than one co-occurring psychiatric illness along with depression" as the most critical predictor, followed by "duration of ICU stay," "severity of depression," "past psychiatric history," and "substance use history."

Conclusion: This study highlights the complex interplay of clinical and psychiatric factors associated with suicidality among post-ICU patients. The findings underscore the importance of comprehensive psychiatric screening and targeted interventions for high-risk individuals during their recovery phase to mitigate suicide risk.

Background: Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders, but concerns about cognitive side effects persist.

Aim: To assess cognitive function changes during ECT in patients with various psychiatric illnesses.

Materials and methods: This prospective observational study included 100 patients (aged 18-60 years) with psychiatric disorders scheduled for ECT at a tertiary care hospital. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at four-time points: before and after the first ECT session, and before and after the third ECT session. The first and third sessions were chosen to capture both acute effects and short-term cumulative changes. Socio-demographic and clinical data were collected using a semi-structured proforma.

Results: The sample comprised patients with schizophrenia (50%), bipolar disorder (22%), major depressive disorder (21%), and obsessive-compulsive disorder (OCD) (7%). Baseline cognitive impairment was observed in 96% of patients. After the third ECT session, there was a significant improvement in the naming domain (P = 0.003) and a trend towards improvement in overall cognitive function (P = 0.075). Patients with schizophrenia and bipolar disorder showed more significant improvements in cognitive function compared to those with other diagnoses. Education level was significantly associated with cognitive outcomes (P = 0.004), with higher education correlating with better cognitive performance.

Conclusion: This study suggests that ECT does not lead to significant cognitive decline in the short term and may improve certain cognitive domains, particularly naming ability. The cognitive effects of ECT vary across different psychiatric diagnoses and are influenced by educational background.

Background: Binge-watching refers to watching multiple television series episodes in one sitting. The concept of narratives and the immersive nature of the storyline are highlighted in the binge-watching phenomenon. Binge-watching has been compared with the addiction model, which impacts both mental and physical health. Different studies in the West have come up with different binge-watch profiles, but in India, the literature on binge-watching is scarce.

Aim: The present study aims to explore the prevalence of binge-watching behavior and determine the relationship between binge-watching and the psychological correlates, namely, stress, depression, anxiety, coping styles, and personality traits.

Materials and methods: The current study was conducted online on a community sample consisting of 235 individuals. Binge-watching behavior was assessed through the Binge-Watching Engagement and Symptoms Questionnaire (BWESQ), and psychological correlates were assessed through DASS 21, Brief COPE, and Big Five Invenrory-2-Short (BFI-2-S).

Results: A high prevalence rate (85%) for binge-watching has been found. Avoidance coping style increases binge-watching behavior. Conscientiousness personality trait decreases binge-watching, and extraversion increases it.

Conclusion: Binge-watching is a prevalent phenomenon in the community and coping styles, and personality traits can influence binge-watching behavior in a bidirectional manner.

This scoping review aims to systematically explore the use of ketamine for treating psychiatric disorders in India, mapping the landscape of research, and identifying gaps in the existing literature. The electronic literature search was conducted using PubMed, Scopus, and Clinical Trials Registry of India databases to identify both published and ongoing studies exploring ketamine's efficacy and safety in treating psychiatric disorders in India. Twenty published studies and 29 trial protocols were included. Published studies comprised case reports (n = 8), case series (n = 2), prospective uncontrolled investigations (n = 5), retrospective reviews (n = 2), and randomized controlled trials (RCTs, n = 3). Most of them focused on ketamine infusion treatment for resistant depression and suicidality. An analysis of trial protocols revealed a significant number of RCTs (n = 26/29), with two non-randomized and one single-arm trial. The majority of trials focused on unipolar depression or suicidality, with other psychiatric conditions such as obsessive-compulsive disorder (OCD) and bipolar depression being explored in some trials. The review of the literature indicated a growing interest in exploring alternative routes of ketamine administration such as oral and subcutaneous, which contrasts with the predominantly intravenous administration reported in published studies. However, careful consideration of dosing, administration routes, and medical supervision is essential to maximize the benefits and minimize the risks. The review highlights the need for more methodologically rigorous research to optimize treatment protocols and expand ketamine's therapeutic applications in psychiatric practice.

Background: Alcohol use disorders (AUDs) are among the most common comorbid psychiatric disorders in patients with adult attention deficit hyperactivity disorder (ADHD), and adult ADHD is an independent risk factor for developing AUD.

Aim: To study the prevalence of adult ADHD in patients with Alcohol dependence syndrome (ADS).

Materials and methods: In total, 177 cases of ADS diagnosed as per International Classification of Diseases-10, Diagnostic Criteria for Research (ICD-10, DCR) were included. The severity of alcohol dependence was estimated by the Severity of Alcohol Dependence Questionnaire (SADQ). The included patients were screened for adult ADHD by the Adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist, and statistical tests were applied.

Results: Out of 177 patients with ADS, 21 patients screened positive for adult ADHD (11.9%). Greater severity of alcohol dependence among those screened positive for adult ADHD was noted compared to the adult ADHD negative group (P = 0.013). Adult ADHD-positive patients had an earlier age of onset of alcohol consumption (P = 0.020), higher mean duration of alcohol consumption (P < 0.001), and early onset of ADS (P = 0.038). ICD-10 criteria of loss of control, salience, and use despite harmful effects were significantly higher among the adult ADHD-positive group.

Conclusion: The study findings suggest a significant prevalence of adult ADHD among patients with ADS.

Background: Antipsychotic drugs have the potential to cause QT-interval prolongation (QTIP), which may lead to Torsades de Pointes and sudden cardiac death. Thus, it is important to know about the incidence and risk factors for QTIP.

Aim: The primary objective of the study was to find out the incidence of QTIP due to the use of antipsychotic drugs in patients with schizophrenia and acute psychosis after two weeks of drug use. The secondary objective was to find the risk factors for QTIP.

Materials and methods: The study included 160 consenting patients, aged ≥18 years, either sex, diagnosed with schizophrenia or acute psychosis, who had not taken oral/water-based injectable antipsychotics during the last 15 days or any long-acting antipsychotic injectable during the previous 6 months. Patients with other psychiatric disorders, substance use other than nicotine/caffeine, low serum levels of potassium/calcium/magnesium, congenital long QT syndrome, history of cardiac conditions, or those taking drugs with high risk to cause QTIP were excluded. ECG was recorded before starting treatment and after at least 2 weeks of treatment with antipsychotic drugs. Corrected QT interval (QTc) was calculated using Fridericia's and Bazett's formulae. QTc >450 ms in males and >460 ms in females was considered prolonged.

Results: The mean age of study participants was 35.88 years (SD: 13.32), and 88 (55%) were males; 138 (86.3%) suffered from schizophrenia. Seventy-one (44.4%) and 74 (46.3%) received risperidone and olanzapine, respectively. Twelve (7.5%) developed QTIP (QTc calculated using Fridericia's formula). Twenty-five (15.6%) were seen to develop QTIP (QTc calculated using Bazett's formula). Additional risk factors for QTIP could not be identified in the study sample.

Conclusion: QTIP is present in a reasonable number of participants. Careful screening and assessment for risk factors that could increase the chances of QTIP must be done regularly in patients getting antipsychotic drugs.

Background: Today, people are living in a digital world where they spend most of their time with electronic devices such as smartphones and computers and are not aware of the influence of the digital world in their life.

Aim: The aim of this study was to explore digital detox experience of people when they were asked to shut off the digital devices from their life for one day.

Materials and methods: The study's findings were based on semistructured interviews with participants who were willing for "a data off" experience. This study included a thematic analysis of the content of interviews from participants.

Results: Data gathered on the basis of these interviews were personal experiences shared by individuals who were abstinent from using digital devices for one day. A total of 2 major themes, discomforts, and benefits were emerged from the primary themes. The primary themes such as psychological difficulties, physical Vicissitudes, and social disquiets together produced the major theme of discomfort. Sense of belonging, mood enhancers, organized life, and health promoting activities contributed to the major theme benefits.

Conclusion: From this study, it can be concluded that digital detox experience is an eye opener for people about how they behave when there is no access to the world of internet. Although they need to struggle to maintain the data off activity, it certainly helped them to understand the way they can actively engage in more fruitful and productive activities which enhances their quality of life.

This text discusses a case report of a pregnant anemic female in her second trimester with a diagnosis of bipolar depression and comorbid obsessive compulsive disorder (OCD). Managing both mood stabilization and obsessive compulsive symptoms simultaneously in a pregnant female presents a real challenge, especially considering that serotonin reuptake inhibitors (SSRI), the first-line treatment for OCD, can induce manic or mixed mood states in bipolar disorder patients. This case is unique in view of limited options left with pregnancy in place. Lamotrigine was chosen as an agent and was introduced in this patient which is rated as FDA pregnancy risk category C which amounts to risk cannot be ruled out (human data lacking, animal studies positive or not done). Patient responded well and maintained well on monotherapy of lamotrigine and showed significant improvement in both symptoms of depression and OCD. USG-level II examination shows no abnormality on repeated scans.

Background: There is a rising trend of alcohol addiction in our Indian society. Studies from high-income countries have demonstrated the effective usage of mobile phones in delivering psychosocial interventions in the treatment of substance disorders.

Aim: To assess the effectiveness of Tele-Counseling as a mode of continuing care for patients with alcohol dependence syndrome.

Materials and methods: An open-label randomized control trial was conducted with 78 male participants. Patients with severe mental disorders or cognitive impairments were excluded. Participants received standard care treatments and were randomly assigned to either the Tele-Continuing Care (TCC) group or the Treatment as Usual (TAU) group. 1) 'Telephone Continuing Care ' group (TCC) who received pro-active contact and counseling through mobile phones from the treatment team on the 1^st, 2^nd, 4^th, 8^th, 12^th, 16^th, 20^th, and 24^th week after discharge. 2) The 'Treatment-As-Usual' group (TAU) received usual outpatient follow-up care. We contacted patients and their caregivers every month over mobile phones, belonging to both groups and collected information regarding drinking status up to one year after discharge. We compared abstinence rates, drinking percentage days, and treatment adherence rates. By including all the variables, we did logistic regression to predict relapse.

Results: The mean age of participants was 41.38 ± 9.06 years, with the majority being married. A higher percentage of patients in the TAU group had higher education qualifications compared to the TCC group. Duration of treatment adherence was significantly (P = 0.017) longer in the TCC group than TAU group (159.83 (120) ±129.47 vs. 100.37 (60) ±112.95) days. Similarly, compliance with abstinence-maintaining medications was better (P = 0.027) in the TCC group than TAU group (142.85 (120) ±115.50 v/s 95.29 (52.5) ±104.42) days. Attendance to group therapy sessions also was better in the TCC group (P = 0.001) compared to the TAU group. However, there was no statistical significance between the two groups in terms of abstinence rate at the end of one year (TCC: 61.8% and TAU: 44.4%) and also the drinking percentage days at the end of one year (TCC 28.22% vs. TAU 38.76%). Logistic regression revealed that a Family History of Alcoholism and Poor Drug compliance were found to be significant predictors of relapse.

Conclusion: As Tele-Counselling Care in our study showed partial effectiveness in improving the outcome measures, research should focus on improvising further to strengthen the Tele-Counselling model, especially in resource crunch Low- and Middle-Income countries and this could be included in the armamentarium of alcohol de-addiction program.