Psychiatry

Violence against doctors in India – Safety versus service Om Prakash Singh Indian Journal of Psychiatry 2019 61(4):325-326

Safety and efficacy of adjunctive transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label trial Satish Kumar, Nand Kumar, Rohit Verma Indian Journal of Psychiatry 2019 61(4):327-334 Introduction: The current pharmacological and psychotherapeutic approaches have limited benefit in symptom management of obsessive-compulsive disorder (OCD) urging clinicians and researchers to seek newer avenues of management. Transcranial direct current stimulation (tDCS) has shown promise in this aspect from a neuromodulatory perspective. The current study aims to study the response to tDCS as an adjunctive treatment in patients with treatment-resistant OCD. Materials and Methods: This open-label study was conducted among 20 patients with treatment-resistant OCD. All participants received 20 sessions of tDCS with the cathode at the supplementary motor area (SMA) and the anode at right occipital area. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the secondary outcome was evaluated on the clinical global impression (CGI) and side effect checklist for tDCS. Results: There was a significant improvement from baseline in the mean scores of Y-BOCS and CGI scales after tDCS intervention. An improvement of >35% Y-BOCS score change was observed in 15% of participants. Short-lasting side effects were reported as mild headache and localized tingling sensation. Conclusion: Cathodal tDCS at SMA may be a useful approach to manage treatment-resistant OCD. The use of tDCS was not associated with any significant harmful consequence to the participants.

Cognitive deficits, depressive symptoms, insight, and medication adherence in remitted patients with schizophrenia V V Jagadeesh Settem, Haridas Karanadi, Samir Kumar Praharaj Indian Journal of Psychiatry 2019 61(4):335-341 Objective: To study the relationship between cognitive deficits, depressive symptoms, insight, and medication adherence in remitted patients with schizophrenia. Methods: Fifty-four patients aged 18–60 years, with schizophrenia in remission, were evaluated for adherence using the Medication Adherence Rating Scale (MARS), cognitive deficits using the Schizophrenia Cognition Rating Scale (SCoRS), depressive symptoms using the Calgary Depression Scale for Schizophrenia (CDSS), and insight using the Beck Cognitive Insight Scale. Results: Twenty-one (38.9%) patients were found to be nonadherent to their medication. A significant negative correlation was found between MARS total score with SCoRS attention/vigilance (r = −0.28), attitude toward negative side effects of the psychotropic medication with SCoRS total score (r = −0.36), SCoRS attention/vigilance (r = −0.27), verbal learning and memory (r = −0.32), reasoning and problem-solving (r = −0.30), and social cognition (r = −0.28). A significant negative correlation was found between CDSS total score with MARS total score (r = −0.50), medication adherence behavior (r = −0.44), and attitude toward negative side effects of psychotropic medication (r = −0.60). MARS total score significantly positively correlated with years in remission (r = 0.29). Conclusions: Poor medication adherence was seen in more than one-third of remitted patients with schizophrenia and was associated with global cognitive deficits, depressive symptoms, and the number of years in remission.

Medication adherence in first-episode psychosis and its association with psychopathology Vijaya Raghavan, Greeshma Mohan, Subhashini Gopal, Mangala Ramamurthy, Thara Rangaswamy Indian Journal of Psychiatry 2019 61(4):342-346 Background: The purpose of the study was to follow-up the individuals with first-episode psychosis (FEP) for a period of 1 year to assess their medication adherence rates and to identify the association between medication adherence and psychopathology. Materials and Methods: In a 1 year longitudinal study, 59 individuals with FEP were assessed for their sociodemographic profile and medication adherence at 1 month and 12-month follow-up period using a semi-structured per forma. Positive and negative symptoms were assessed by positive and negative syndrome scale (PANSS) while the functioning by global assessment of functioning (GAF) scale. Results: Nearly 85% of the individuals were adherent with medications during the 1-month follow-up period, 32.2% were poorly adherent at the end of 12 months. Among various factors examined for association with medication adherence, positive and negative symptoms, and global functioning of the individuals at the end of 12 months were found to significant associated with poor medication adherence. Conclusion: There is a high rate of medication nonadherence in individuals with FEP at 12-month follow-up, and factors affecting nonadherence should be addressed specifically to improve medication adherence in these individuals.

Suicides of Punjabi hawkers in 19th- and early 20th-century Australia Dirk H R Spennemann Indian Journal of Psychiatry 2019 61(4):347-351 Background: During the late nineteenth century, a considerable number of young Punjabi men sought their fortunes in the Australian colonies, working as hawkers and farm labor. While in Australia they experienced marginalization and high levels of racial vilification by the Anglo-Celtic settler community. Aims: To assess the frequency and nature of suicides of Punjabi workers in nineteenth century Australia. Materials and Methods: The paper draws on archival sources and contemporary newspaper reports. Results: A wide range of methods of suicides were observed, with drowning the preferred method. Conclusions: This article is the first to collate the data on the suicides and suicide attempts by young Punjabi men working in an immigration country. It can be shown that the suicide rate among Punjabi was almost six times higher than that of the host community.

Delirium in medical intensive care units: Incidence, subtypes, risk factors, and outcome Ayush Kumar Jayaswal, Harshavardhan Sampath, Geeta Soohinda, Sanjiba Dutta Indian Journal of Psychiatry 2019 61(4):352-358 Background: Delirium is a frequent yet underdiagnosed neuropsychiatric condition encountered in intensive care units (ICUs). Being both a preventable and potentially reversible process associated with significant morbidity and mortality, understanding risk factors that predispose and precipitate delirium in any given patient are critical in ICUs. Aims and Objectives: The aim of this study is to evaluate the incidence, motor subtypes, risk factors, and clinical outcome of delirium in the medical ICU. Materials and Methods: We used a prospective study design on a cohort of consecutive medical ICU admissions of a tertiary care teaching hospital. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose and motor subtype delirium, respectively, along with a checklist to assess risk factors. Results: Of the 280 ICU admissions, 88 (31.4%) developed delirium. Hypoactive delirium was the most common motor subtype (55.7%). The detection rate of delirium was 12.5% (lowest for hypoactive delirium at 2.04%). Age, gender, and years of education did not significantly predict delirium (all P > 0.05). Tobacco use, chronic liver disease, and past episodes of delirium significantly predisposed, while mechanical ventilation, hypoxia, fever, raised levels of bilirubin and creatinine, and benzodiazepine administration significantly precipitated ICU delirium. Delirium was significantly associated with longer ICU stay (t = 4.23, P = 0.000) and 1-month postdischarge mortality (χ2 = 6.867, P = 0.009). Conclusion: Detection of delirium is challenging, especially in ICU patients on mechanical ventilation and hypoactive delirium. Screening and monitoring for predisposing and precipitating risk factors can greatly improve the odds of detection and intervention as ICU delirium is associated with significant morbidity and mortality.

Age of onset of substance use in patients with dual diagnosis and its association with clinical characteristics, risk behaviors, course, and outcome: A retrospective study Bhagyalakshmi Nanjayya Subodh, Swapnajeet Sahoo, Debasish Basu, Surendra Kumar Mattoo Indian Journal of Psychiatry 2019 61(4):359-368 Research Question: Do patients with dual diagnosis (DD) with an early initiation of substance use and subsequent early onset substance use disorder (EOS) differ from those with late onset substance use disorder (LOS) regarding characteristics, sex-related risk behaviors, course, and outcome? Objectives: The aim is to study EOS and LOS groups of patients with DD attending a treatment center with regard to clinical characteristics, type of psychiatric disorders, risk behaviors, and short-term outcome. Materials and Methods: Retrospective chart review of patients diagnosed with DD (n = 307) with regard to the above variables. Diagnoses of both substance use disorders (SUDs) and psychiatric disorders were made by qualified psychiatrists as per the International Classification of Diseases, 10th revision. Results: Among 307 participants with DD, 100 were in EOS group (onset of SUD before 18 years of age as assessed clinically) and 207 in LOS group. Cannabis as the primary substance was more prevalent in the EOS (30%) than that of the LOS group (12%). Psychotic disorders were more prevalent in the EOS group (41%) followed by mood disorders (30%), while the reverse was true in the LOS group (27.5% and 56.5%, respectively). When compared to the LOS group, the EOS group had higher number of psychiatric admissions, reported higher prevalence of risky sexual behaviors (unprotected sexual intercourse, multiple sexual partners, and history of sexual intercourse with commercial sex workers), showed poorer treatment adherence, and worse outcome regarding both psychiatric disorder and SUD (all differences significant at P < 0.05). Conclusions: DD patients differ significantly based on the age of onset of substance use. These may have therapeutic and management implications.

Swavlamban Health Insurance scheme for persons with disabilities: An experiential account Joseph Wilson James, Chethan Basavarajappa, Thanapal Sivakumar, Ruma Banerjee, Jagadisha Thirthalli Indian Journal of Psychiatry 2019 61(4):369-375 Context: Out-of-pocket expenditure on health in India is high. Many people including persons with disability (PwD) face catastrophic health expenditure. Health insurance is a promising strategy to overcome this burden. Swavlamban was the first health insurance for PwD which also covered mental illness. We conducted regular camps at the National Institute of Mental Health and Neurosciences (NIMHANS) for enrollment in the scheme. In this study, we present the features of the scheme and the sociodemographic profile of beneficiaries enrolled. Aims: To describe the experience of conducting enrollment camps for the Swavlamban Health Insurance scheme at NIMHANS and the sociodemographic profile of beneficiaries enrolled. Settings and Design: The study comprised all PwD and their family members enrolled in the Swavlamban through the camps conducted at NIMHANS from May 2016 to April 2017. Results: A total of 1248 persons were enrolled, of which 643 were PwD. The beneficiaries (PwD) were predominantly male (69%), with a mean age of 31 years, from Bengaluru (84%), and majority had disability due to mental retardation (43%). Although camps were conducted in mental hospital and publicized among mental health professionals, only 135 persons disabled with mental illness (21% of PwD beneficiaries) were enrolled. Conclusions: Mental health professionals need to take the lead in coordinating with various stakeholders so that the PwD can avail health insurance and other welfare benefits. There is a need to lobby and advocate for making these schemes easily accessible.

Video-assisted teaching versus traditional didactic lecture in undergraduate psychiatry teaching Mona Nongmeikapam, N Sarala, Mohan Reddy, S Ravishankar Indian Journal of Psychiatry 2019 61(4):376-379 Objectives: The objectives of this study are as follows: (1) To compare video-assisted teaching versus didactic lectures using the pretest and posttest. (2) To compare the feedback on the two teaching methods using a teaching feedback form. Materials and Methods: Two consecutive batches of 22 and 20 students, respectively, of the 3rd year medical undergraduate students posted to the department of psychiatry were included for the study. The first batch underwent video-assisted schizophrenia class and didactic lecture in bipolar disorder (BPAD). A crossover of the topics was done. The students underwent pretest and posttest for each topic using the same set of topic-specific validated multiple choice questions and also filled a prevalidated teaching feedback form for each class. Results: Difference between pre- and post-test scores after all classes was significant, indicating effective gain of knowledge by both methods. Feedback analysis indicated that most students favored video-assisted teaching (total mean feedback score – 61.99) compared to the conventional method (total mean feedback score – 60.58). Increase in mean feedback scores indicates the students' preference. Conclusion: Both didactic and video-assisted lectures were effective in terms of knowledge gained and students' feedback. Using video assistance as a complement to lectures and not to replace the traditional methods is the way forward.

Burden, coping mechanisms, and quality of life among caregivers of hemodialysis and peritoneal dialysis undergoing and renal transplant patients M Nagarathnam, Vishnubotla Sivakumar, S A A Latheef Indian Journal of Psychiatry 2019 61(4):380-388 Context: Investigations on burden, coping, and quality of life (QOL) in caregivers of hemodialysis (HD) and peritoneal dialysis (PD) undergoing and renal transplant (RT) patients may lead to the well-being of caregivers, and these studies are sparse and nil in Indian context. Aim: This study aims to comparatively evaluate the burden, coping mechanisms, and QOL among caregivers of HD and PD undergoing and RT patients. Setting and Design: Tertiary care hospital, cross-sectional and descriptive study. Subjects and Methods: Burden, coping mechanisms, and QOL in caregivers of HD and PD undergoing and RT patients were investigated using Zarit burden interview, revised ways of coping and short-form 36 in 30 each caregivers of HD and PD undergoing and RT patients. Results: Moderate to severe burden, mild to moderate burden, and no burden were observed in the majority of caregivers of HD and PD undergoing and RT patients. Significantly higher mean burden score in caregivers of HD undergoing than RT patients (P < 0.01); accepting responsibility in caregivers of RT than PD undergoing patients; social functioning in caregivers of HD than PD undergoing patients; and general health in caregivers of RT than HD undergoing patients, was observed. Lower physical component was common in each group, whereas accepting responsibility in HD, self-controlling in PD, and age and escape avoidance in RT were found to be the specific predictors of the burden score. Conclusions: Caregivers of HD and PD undergoing and RT patients have different levels of burden, use different mechanisms to cope, and showed different predictors of burden score.