Building psychological resilience in Armed Forces worldwide.

Psychological resilience among troops can be enhanced through relatively simple interventions. Globally, various Armed Forces have successfully implemented modules for building psychological resilience. Programs from different countries are listed, evaluated and their underpinnings explored. Recommendations for a variety of feasible and culturally acceptable interventions targeted at individuals, families, units, community and organizations in the Indian context have been made; ranging from mindfulness training to embedded combat psychologists. Interventions are likely to succeed if integrated within existing basic training and unit/career programs.

Adding pre-emptive anticholinergics to antipsychotics: Is it justified?

Anti-psychotics are the mainstay of treatment for Schizophrenia and psychotic disorders. Historically, anticholinergics have been prescribed to prevent or treat extrapyramidal side effects (EPS) associated with first-generation antipsychotics (FGAs). Even though newer antipsychotics are associated with markedly lower rates of EPS, concurrent anticholinergic use remains high. Use of these medications has potential for long-term side effects, worsening of EPS and poor adherence. We have briefly discussed the limited association between second-generation antipsychotics (SGAs) and EPS, the efficacy of anticholinergics for different types of EPS, and summarized various national and international guidelines on the subject. In conclusion, there is no evidence for prophylactic use of anticholinergics with antipsychotics. Clinicians need to guard against this tendency to be unduly cautious.

Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do?

Background: Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio. Methodology: Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio. Results: One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable. Conclusion: It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.

Risk factors of postpartum depression.

BACKGROUND: Postpartum depression (PPD) is one of the most common puerperal psychiatric illnesses impairing quality of life and mental health of the mother and also the child. AIM: The aim is to study the prevalence and risk factors of PPD. MATERIALS AND METHODS: This cross-sectional observational study was done on a sample of 295 mothers who delivered and were followed up at a tertiary care hospital. The mothers were administered Edinburgh Postnatal Depression Scale, and demographic, psychosocial, and clinical data were collected. RESULTS: The age of the participant mothers ranged from 18 to 35 years and age at marriage ranged from 21 to 24 years. In most of the mothers, the parity was 2 and they had institutional vaginal delivery. The prevalence of PPD in this population of mothers was 30.84%. The factors that had a statistically significant association with PPD included: lower educational status of mother, lower family income, rural place of residence, higher parity, preterm delivery, and adverse events in newborn. CONCLUSION: PPD is a common mental health problem in the postpartum period. Sociodemographic factors such as low educational status of mothers, rural population, and low monthly family income were found to be associated with PPD. Primipara status, preterm delivery, and adverse events in newborn were also significantly associated.

Prevalence and risk factors associated with Internet gaming disorder: A cross-sectional study.

BACKGROUND: Internet gaming disorder (IGD) is an entity of clinical attention prominent among schoolgoing students. The reported nature and extent of Internet gaming varies widely, as does the extent of its effects. AIM: This study aimed to assess the prevalence of IGD and factors associated with it. METHODS: After institution ethics approval, individual assent, and parental consent, a cross-sectional study was conducted among 142 students of a school in western Maharashtra. A specially designed sociodemographic pro forma and IGD Scale were administered to the students. Data thus generated were statistically analyzed and compared with published literature. RESULTS: The prevalence of IGD was 10.6% among 13-19-year-old students. It was significantly higher among male students (15.3%) than female students (3.5%). Multivariate logistic regression found IGD to be significantly associated with male gender and lower age at first gameplay. CONCLUSIONS: IGD affects a tenth of our schoolgoing population with a male preponderance. Lower age at first gameplay had an adverse association.

Lorazepam challenge test: A unique clinical response in catatonia.

Catatonia is a psychomotor behavioral syndrome characterized as a complex syndrome of bizarre motor behavior, impaired volition, and vegetative abnormalities. Catatonia is a medical emergency and if not recognized on time may have potentially fatal outcomes. We present a case series of three patients with catatonia, in whom Injection lorazepam 4 mg administered intravenously (Lorazepam Challenge) produced quick, optimum outcome.

Alzheimer's disease: Newer biomarkers.

Fifty million people are affected with dementia worldwide with Alzheimer's disease (AD) accounting for 70%-80% of these cases. In India alone, 4.1 million people suffered from dementia in 2015. To date, there are no definitive treatment options for AD and the overall treatment gap in India stands at 90%. Attempts have been made to define AD biologically. This has been made possible due to advances in the identification of biomarkers that indicate the neuropathological changes responsible for AD. Identification of these biomarkers has implications for disease staging, prognostication, and identifying drug targets. Here, we summarize the advances in the field of biomarkers in AD.

Impact of breathing and relaxation training (Sudarshan Kriya) on cases of alcohol dependence syndrome.

BACKGROUND: Alcohol abuse is a public health problem and the course of alcohol dependence syndrome (ADS) is known for its relapsing nature. Additional interventions with empirical evidence are worthy of consideration. Breathing and Relaxation Training, like Sudarshan Kriya (SK) is recommended for stress management, and have been shown to positively affect outcomes in stress-related disorders. The aim of this study was to assess the effect of an intervention of Breathing and Relaxation Training, on drinking behavior in patients of ADS. METHODOLOGY: Eighty in-patients diagnosed with ADS were included after obtaining informed consent, in this prospective study and were randomized into two groups. They were administered Alcohol Use Disorder Identification Test (AUDIT) at admission and 6-months after discharge. The Study group (n = 40) underwent a 6-day intervention of Breathing and relaxation Training (SK) apart from the standard therapy. "WHO-5 Well-Being Index" was administered before and after the training. The Control group was exposed to the standard therapy for ADS. A follow-up on a monthly basis and finally at 6-month interval was done to assess alcohol consumption status. RESULTS: Socio-demographically both the groups were comparable. The breathing and relaxation training (study) group had a significant rise in "WHO-5 Well-Being Index" (P < 0.001). There was a significant reduction in AUDIT scores after 6 months in both groups. AUDIT scores were significantly lower in the study group (11.20 ± 2.81) than the control group (15.30 ± 4.05) after 6 months (P < 0.001). The study group also reported fewer days of drinking (P = 0.004) and reduced overall drinking in the intervening period (P < 0.001). CONCLUSION: The addition of Breathing and Relaxation Training (SK) in the management of ADS provided additional therapeutic benefits in the form of fewer days of drinking and reduced total alcohol consumption.

Available videoconferencing freeware and medical education.

BACKGROUND: Traditionally medical education involves classroom teaching, small group discussions and bed-side clinics. These have become difficult to conduct in times of the COVID-19 pandemic. Video-conferencing software and apps provide pragmatic alternatives for medical education in this scenario. However, the apps are not designed specifically for medical education. In this background, we aimed to review available video-conferencing freeware (platforms/apps) for their suitability in imparting post-graduate medical education. METHODOLOGY: Software and apps were searched on Android and iOS platforms. Freeware were selected based on pre-defined criteria. They were evaluated for features supporting post-graduate medical education like participant numbers, time limit, user comfort and security features. RESULTS: Our search yielded 118 video conferencing software and apps. Of these, 07 free apps met the initial inclusion and exclusion criteria. 'Say Namaste' was included post-hoc. Most apps allowed adequate numbers of participants and were comfortable for users. Only two apps had end-to-end encryption. CONCLUSION: Video-conferencing freeware can serve as a viable alternative for some aspects of medical teaching. Provision of certain additional features would make these apps more effective for post-graduate medical education.

To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events.

BACKGROUND AND OBJECTIVES: Relapse is a complex and dynamic phenomenon that appears to be determined by biological, psychological, and social factors and an interaction among these. This study examined the association between demographic variables, clinical parameters, and psychosocial factors that predict the vulnerability to relapse in cases of alcohol dependence syndrome. MATERIALS AND METHODS: Structured assessments of clinical/demographic parameters, relapse precipitants, life events, and dysfunction were carried out among patients with alcohol dependence syndrome (n = 100) who had relapsed and compared with those (n = 100) who had managed to remain abstinent. RESULTS: Patients who had relapsed were found to have significantly more positive family history of substance use, past history of alcohol-related comorbidity, experienced a higher number of undesirable life events, and higher negative mood states and social anxiety and dysfunction in social, vocational, personal, family, and cognitive spheres compared to patients who had remained abstinent. CONCLUSIONS: Relapse in alcohol dependents is an interaction of many factors, and multiple layers of assessment may be required to predict relapse. This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It provides the basis for investigating the correlates of relapse in a wide range of behavioral and substance use problems.

Cross-sectional study of anxiety symptoms in students in preexamination period.

BACKGROUND: Preexamination period is an exceptionally stressful time for schoolgoing children and adolescents, and the propensity of having anxiety symptoms increases. AIM: This study aimed to assess the presence of anxiety symptoms in students in preexamination period. MATERIALS AND METHODS: The study was carried on 619 children from Class VIII to XI. All of them were given a structured questionnaire for sociodemographic profile and Screen for Child Anxiety Related Emotional Disorders questionnaire. Association of various variables with presence of anxiety symptoms was assessed. Statistics was analyzed with SPSS version 17.0 software. RESULTS: Totally 170 children (27.5%) had anxiety symptoms, similarly the various subgroups had increased frequency compared to the known prevalence in this age group. Age, years spent in the current school, living with parents, presence of domestic stressors, and grade deterioration, all were significantly associated with increased frequency of these symptoms. Similarly, association with various subgroups is described. CONCLUSION: This study attempts to give evidence of increased anxiety symptoms, during preexamination phase, compared to the reported prevalence in this age group, and thus to address this becomes imperative which will improve their performance and also the mental health preventing distress along with psychological and behavioral problems.

Valproate induced hyperammonemic encephalopathy treated by haemodialysis.

Valproate (VPA)-induced hyperammonemic encephalopathy is an unusual, but serious, adverse effect of divalproex sodium (DVPX) treatment and if untreated can lead to raised intracranial pressure, seizures, coma, and eventually death. It can, however, be reversed if an early diagnosis is made. It is therefore extremely important to recognize it and discontinue DVPX treatment. Our patient developed sudden deterioration of sensorium, drowsiness, lethargy, and later severe comatose state after few days of starting DVPX with high levels of serum ammonia despite therapeutic levels of VPA and normal liver function test. He responded to hemodialysis, cerebral decongestants, and other intensive supportive measures.

Two cases of male genital self-mutilation.

Male genital self-mutilation (GSM) is a rare but serious phenomenon. Some of the risk factors for this act are the presence of religious delusions, command hallucinations, low self-esteem, and feelings of guilt associated with sexual offences. Other risk factors include failures in the male role, problems in the early developmental period, such as experiencing difficulties in male identification and persistence of incestuous desires, depression, and having a history of GSM. The eponym Klingsor Syndrome, which involves the presence of religious delusions, is proposed for GSM. Psychiatric case reports of male GSM in the literature are rare and mostly anecdotal.

Social Support and Treatment Outcome in Alcohol Dependence Syndrome in Armed Forces.

INTRODUCTION: Social factors play vital role in unfolding of alcohol use disorders in any given population. Several factors beyond the confines of treatment settings influence treatment outcome in alcohol dependence syndrome. Social support has positive effect in treatment outcome of alcohol dependence syndrome. This has not been much studied in India in past. Therefore we decided to study the perception of social support in cases of alcohol dependence syndrome admitted in a busy hospital in armed forces. AIM: The aim was to study the perception of social support across relapsed and abstinent group and see if it reached any statistical proportion and also to see if any socio-demographic variables also affected perception of social support. MATERIALS AND METHODS: Fifty five consecutive male patients of alcohol dependent syndrome without a co-morbid neurological/psychiatric diagnosis were assessed for their perception of social support after taking informed consent. They were explained the procedure and their alcoholic milestones were recorded in specially designed pro-forma. Subjects were then divided in abstinent and relapsed group. Subsequently they were assessed for their perception of social support by administering Social provision scale and Social support questionnaire. STATISTICAL ANALYSIS: Data were tabulated and statistically analysed by using chi square test, Mann Whitney U-Test and Rank ANOVA test where applicable p-value <.05 was taken as significant. RESULTS: Results indicated that perception of social support across abstinent (n=18) and relapsed (n= 37) group reached significant statistical proportion as measured by social provision scale and social support questionnaire. Duration of use, dependence and family history of alcoholism did not influence perception of social support across patient population. There was inverse relationship between patients with alcohol related problem and their perception of social support. Professional and qualified soldiers perceived higher social support than soldiers and lesser qualified individuals. CONCLUSION: Abstinent group perceived better social support than relapsed group and soldiers in upper socio-occupational status and less alcohol related problems perceived more social support than soldiers with lower socioeconomic status and more alcohol related problems. Psychosocial therapy must be incorporated in management of Alcohol dependence syndrome.

Impact of UV-B radiation on thylakoid membrane and fatty acid profile of Spirulina platensis.

Ultraviolet-B (UV-B) radiation to thylakoid membrane and fatty acid profile has been investigated in cyanobacterium, Spirulina platensis. The thylakoid membrane was isolated by mechanical disruption of the freeze-dried and lysozyme-treated cells followed by differential density gradient centrifugation and morphological variations were examined. UV radiation distorted the membrane on the outer side with reduced chlorophyll a (chl a) content compared to its untreated counterpart. Liquid chromatography-mass spectrometry (LC-MS) was used for characterization of chl a of the thylakoid membrane. UV-B exposure resulted in alterations in the pigment-protein complexes 47 kDa and 43 kDa. Furthermore, 94 kDa and 20 kDa protein appeared in UV-B-exposed thylakoid membrane of S. platensis. The composition of fatty acid in response to UV-B radiation was detected by gas chromatography-mass spectrometry having 23.5% saturated fatty acid (SFA), 76.4% monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA). In contrast to its UV-B-untreated counterpart, SFA was 46.6%, and MUFA and PUFA were 53.3%. Our findings suggest that UV-B radiation not only affects membrane morphology and its protein profile but also reduces saturated fatty acid and increases unsaturated fatty acids in S. platensis.

Desmodium gangeticum: a potent anti-ulcer agent.

The present study was designed to investigate anti-ulcerogenic property of ethanolic extract of Desmodium gangeticum (DG) against cold restraint (CRU, 2 hr cold restraint stress), aspirin (ASP, 150 mg/kg orally), alcohol (AL, absolute alcohol 1 ml/200gm) and pyloric ligation (PL, 4 hr pylorus ligation) induced gastric ulcer models in Sprague Dawley rats, and histamine (HST, 0.25 mg/kg) induced duodenal ulcer in guinea pigs. We found that DG at a dose of 200mg/kg, (orally), markedly decreased the incidence of ulcers in all the above models. DG showed significant protection against CRU (68.37%), AL (88.87%), ASP (38.2%), PL (40.63%) and HST (63.15%) induced ulcer models, whereas standard drug omeprazole (OMZ) showed protection index of 83.86, 56.35, 70.31 and 84.21%, respectively in CRU, ASP, PL and HST models. Sucralfate as standard drug showed 92.64% protection in AL model. DG significantly reduced acid secretion 41.61%, whereas OMZ produced 43.13% reduction. Treatment with DG showed increase in mucin secretion by 56.17%, whereas OMZ showed 12.45% increase. Anti-ulcer effect of DG may be due to its cytoprotective effect along with antisecretory activity and could act as a potent therapeutic agent against peptic ulcer disease.