The prevalence of depression in people following limb amputation: A systematic review and meta-analysis.

OBJECTIVE: To estimate the prevalence of depression in people with limb amputation. Additionally, factors affecting the prevalence or pattern of depression following limb amputation were explored. METHODS: Systematic literature search to identify all relevant studies assessing prevalence of depression following limb amputations was conducted through following databases: PubMed/ MEDLINE, Scopus, Embase, and Web of Science. Search period was since inception of database till December 2021. Meta-analyses using random-effects model were conducted to estimate pooled prevalence of depression. RESULTS: A total of 61 studies comprising 9852 limb amputees were included. Pooled prevalence of depression following limb amputations was 33.85% (95% CI: 27.15% to 40.54%), with significant heterogeneity (I2 = 98.57%; p < 0.001). Sub-group meta-analysis showed that pooled prevalence of depression was significantly higher in studies conducted from middle-income (45.31%, 95% CI: 28.92% to 61.70%) as compared high income countries (28.31%, 95% CI: 23.97% to 32.64%). Greater activity restriction, amputation-related body image disturbances, social discomfort, perceived vulnerability regarding disability, and avoidant coping style were commonly reported factors associated with greater depression symptomatology. Whereas, good perceived social support, and use of more active coping strategies were commonly reported protective factors. CONCLUSION: About one-third of all limb amputees suffered from clinically significant depression. This emphasizes need to sensitize health care professionals involved in providing care to people following limb amputation regarding the importance of periodically screening this vulnerable group of patients for depression and liaising with psychiatrists. Further, addressing risk factors identified in this review could help in reducing the rates of depression post-amputation.

Pathways to care and barriers in treatment among patients with Dissociative disorders.

INTRODUCTION: Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. METHODS: Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. RESULTS: 133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. CONCLUSION: Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.

A randomized controlled trial of brief intervention for patients with cannabis use disorder.

Objectives: Effective interventions for cannabis use disorders are fairly limited. The present randomized controlled trial (RCT) aimed to compare the reduction in cannabis use (number of days cannabis used) with brief intervention and simple advice in patients with cannabis use disorder. Materials and Methods: This non-blinded and parallel two-group RCT included 100 male patients with cannabis use disorder. A semi-structured pro forma and severity of dependence scale (SDS) were used. Participants were then randomized to either of the two arms (brief intervention and simple advice) in a 1:1 ratio. Cannabis use patterns and SDS scores were assessed over the phone at week 4, week 8, and week 12. Results: The two groups were comparable in sociodemographics and cannabis use characteristics. Participants in both groups were using cannabis for 30 days in the past month before enrolment. The brief intervention group had a lesser number of days of cannabis use vis-a-vis the simple advice group at 4, 8, and 12 weeks. There was a significant time effect for change in SDS scores (F = 30.629, P < 0.001), but the group effect was not significant (F = 0.379, P = 0.541). Conclusion: In this population of regular cannabis users, brief intervention may be useful in reducing cannabis usage. It can be integrated into routine assessments and management of those with regular use of cannabis.

The Top 100 Most Cited Publications on Suicide: A Citation Analysis.

Suicide is one of the leading causes of death globally and a matter of public health concern. Biomedical research on suicide has grown exponentially over the past few decades. Although numerous articles are published on suicide, only some exert significant influence in the evolution of scientific understanding. The number of citations a publication receives are a proxy marker of its impact on the field. Hence we aimed to analyze 100 top-cited articles on suicide till May, 2023, using Google scholar as the search database. These citation classics provide important insights into the historical development and trends in suicide research.

Comparative assessment of the information available on the treatment of depression over websites in English and Hindi language.

Background: The study aimed to perform a cross-sectional comparative assessment of the content and quality of information available on the treatment of depression over websites in English and Hindi language. Materials and Methods: We screened the first 50 links obtained on searching for depression treatment on Google, and selected 72 (44 in English; 28 in Hindi) websites. They were evaluated for coverage of different aspects of depression, quality of treatments mentioned, esthetics, and interactivity. Results: A significantly lesser number of Hindi websites discussed the minimum duration of treatment needed for a depressive episode (36% vs. 79%), possible side effects of treatment (18% vs. 77%), discussed suicidality in depression explicitly (25% vs. 57%), or recommended consultation with a mental health professional (11% vs. 43%). English websites more commonly mentioned psychotherapy (86% vs. 64%), electroconvulsive therapy (64% vs. 21%), and social support measures (59% vs. 32%) for depression treatment. Whereas, Hindi websites more commonly mentioned Ayurvedic/herbal medicines (46% vs. 16%), and yoga (29% vs. 4%) for treatment. Lastly, the esthetics score for English websites was significantly higher than for Hindi websites. A significantly greater number of Hindi websites were owned by commercial entities. Conclusion: This is the first study to systematically compare online information on depression treatment in English and Hindi language websites, and identify areas for further improvement in the overall quality of online information in Hindi. There is a need for the creation of credible and accessible online resources in regional languages like Hindi for the promotion of depression literacy among the general public by government and non-profit professional organizations.

Portrayal of Suicide in Bollywood Movies Over Last Two Decades: A Content Analysis.

Aim: To analyse Bollywood movies depicting suicides, released in last two decades, on content and scientific accuracy. Methodology: Online movie databases, blogs were accessed along with Google search to compile a list of movies portraying suicide (thought, plan, or act) in at least one character. Each movie was screened twice for details of character, symptoms, diagnosis, treatment, and scientific accuracy of depiction. Results: Twenty-two movies were analyzed. Most characters were middle-aged, unmarried, well educated, employed and affluent. Most common motives were emotional pain and guilt/shame. Most suicides were impulsive, method of choice was fall from height and resulted in death. Conclusion: Cinematic depiction of suicide may promote misconceptions among viewers. Alignment of cinematization with scientific knowledge is needed.

Astral Projection: A Strange Out-of-Body Experience in Dissociative Disorder.

Out-of-body experiences (OBEs) are hallucinatory visual experiences that involve seeing the physical body placed in an external visual space. Many psychiatric disorders, brain dysfunctions, pharmacological agents, and altered psychological states are reportedly associated with these phenomena. OBEs have been linked to various brain lesions, particularly in the parietal and temporal regions, psychiatric disorders, severe emotional states like a near-death experience, substance use, migraine, and epilepsy, but very few have been reported in dissociative identity disorder. In this report, we present the case of a 15-year-old male patient who described a strange experience where he found himself to be floating outside his own body while he visualized his own body from a third-person perspective. On further evaluation, a diagnosis of dissociative identity disorder and dissociative fugue was formulated. The patient showed improvement after undergoing abreaction, hypnosis, and relaxation training along with supportive psychotherapy. Dissociative disorders occur due to an internal conflict between ego and self, when a person is unable to successfully repress a traumatic experience, or when a repressed memory or experience comes out of the cocooned barrier, leading to an altered state of perception and self-experience, which is described by the patient as OBE. This report presents a scarce differential in the context of psychiatric illness, which might be helpful in the formulation of approaches toward management in cases of such OBE, making it a strange yet intriguing addition to the literature.

Sildenafil Misuse for its Psychoactive Properties? A Case Report.

Sildenafil is a widely used drug for the treatment of erectile dysfunction in a dosage ranging from 50 to 100 mg per day. Recreational use is reported among youth for its sexual function enhancing effects. To date, however, no study has reported the use of sildenafil for its nonsexual, psychoactive effects. We report a case of a 38-year-old male with opioid and sedative use disorder who self-administered sildenafil orally in a dose of up to 2000 mg per day for its psychoactive effects (primarily) for 10 years before seeking treatment and discuss the literature relevant to the case.

Single-stage preputial skin flap urethroplasty for long-segment urethral strictures: evaluation and determinants of success.

OBJECTIVE: To determine the overall efficacy and predictors of success of the penile preputial flap in the management of complex urethral strictures >2.5 cm in length. PATIENTS AND METHODS: We performed a retrospective and prospective study of 58 patients undergoing single-stage penile preputial flap urethroplasty for complex long-segment urethral strictures, without lichen sclerosus, repaired between May 2005 and April 2012 at our institution. For obvious reasons circumcised patients were excluded from the study. Results were assessed by univariate analysis of various patient characteristics, preoperative and postoperative patient satisfaction (based on symptoms), and urethral ultrasonography, retrograde urethrography and uroflowmetry. RESULTS: The median (range) follow-up was 42 (6-90) months, the median (range) intra-operative stricture length was 48.5 (26-85) mm and the median (range) operating time was 90 (85-125) min. A total of 87.93% of patients had a satisfactory outcome, with an overall success rate of 81.03%. Diabetes mellitus (relative risk [RR] 5.21, confidence interval [CI] 2.31-64.68, P = 0.003) and smoking (RR 4.19, CI 1.54- 45.0, P = 0.01) were predictors of failure, while postinfective aetiology (RR 2.19), panurethral stricture (RR 2.73), stricture length >70 mm (RR 3.25), previous urethroplasty (RR 2.4) and severe peri-urethral fibrosis (RR 2.37) were also associated with a higher risk of failure. CONCLUSIONS: A urologist should try to gain experience of all the methods of urethroplasty as the techniques may vary according to the circumstances. Single-stage preputial skin flap urethroplasty, in experienced and expert hands, has results equivalent to all other methods of urethroplasty in complex urethral strictures. We prefer this technique in this part of the world where buccal mucosa cannot be used because of dyskeratotic changes as a result of consumption of gutkha, tobacco, pan masala, betel nut.