Coping in residual schizophrenia: Re-analysis of ways of Coping checklist.

BACKGROUND & OBJECTIVES: Persons with schizophrenia use various coping strategies to adapt to distressing symptoms as well as to deal with daily stressors. Efforts have been made to explore alternative frameworks of coping using Ways of Coping Checklist (WCC) in persons with schizophrenia. This study aimed to re-analyze (factor analysis) the revised-WCC in Indian patients with residual schizophrenia. The secondary aim of the study was to evaluate the relationship of new framework of coping with psychopathology, disability and quality of life (QOL). METHODS: Using a cross-sectional design, 103 patients with residual schizophrenia were assessed on WCC. A principal component analysis with varimax rotation was carried out to determine the factor structure of WCC. RESULTS: Factor analysis yielded six factors which explained 51.6 per cent of the total variance and had acceptable-to-good internal consistency. Based on the type of items loaded, the six factors were named as follows: active and growth-oriented coping, accepting and fantasizing, reflective and confrontative coping, detachment, seeking social support and negative emotional coping. Patients most often used coping strategy of seeking social support, followed by 'accepting and fantasizing' and 'active and growth-oriented coping'. Correlation analysis showed that those who more often used 'active and growth-oriented coping' had less negative symptoms, lower level of disability and higher spiritual and overall QOL. INTERPRETATION & CONCLUSIONS: The factor structure of revised-WCC was different among patients with schizophrenia when compared with individuals without mental illness, living in the community. It was evident that use of certain adaptive coping strategies was associated with better QOL and lower level of psychopathology. Our findings provided a framework of coping in patients with residual schizophrenia and suggested that promotion of certain coping strategies might be useful in improving the QOL and reduction of psychopathology in patients with schizophrenia.

Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module.

BACKGROUND & OBJECTIVES: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. METHODS: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. RESULTS: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. INTERPRETATION & CONCLUSIONS: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.

Internal consistency & validity of Indian disability evaluation and assessment scale (IDEAS) in patients with schizophrenia.

BACKGROUND & OBJECTIVES: The Indian Disability Evaluation and Assessment Scale (IDEAS) has been recommended for assessment and certification of disability by the Government of India (GOI). However, the psychometric properties of IDEAS as adopted by GOI remain understudied. Our aim, thus, was to study the internal consistency and validity of IDEAS in patients with schizophrenia. METHODS: A total of 103 consenting patients with residual schizophrenia were assessed for disability, quality of life (QOL) and psychopathology using the IDEAS, WHO QOL-100 and Positive and Negative symptom scale (PANSS) respectively. Internal consistency was calculated using Cronbach's alpha. For construct validity, relations between IDEAS, and psychopathology and QOL were studied. RESULTS: The inter-item correlations for IDEAS were significant with a Cronbach's alpha of 0.721. All item scores other than score on communication and understanding; total and global IDEAS scores correlated significantly with the positive, negative and general sub-scales, and total PANSS scores. Communication and understanding was significantly related to negative sub-scale score only. Total and global disability scores correlated negatively with all the domains of WHOQOL-100 (ρ<0.01). The individual IDEAS item scores correlated negatively with various WHOQOL-100 domains (ρ0< 0.01). INTERPRETATION & CONCLUSIONS: This study findings showed that the GOI-modified IDEAS had good internal consistency and construct validity as tested in patients with residual schizophrenia. Similar studies need to be done with other groups of patients.

Outcomes and predictive factors for salvage therapy after local--regional recurrence following neoadjuvant chemotherapy and breast conserving therapy.

BACKGROUND: There are few data addressing local-regional recurrence (LRR) and salvage therapies in patients treated with neoadjuvant chemotherapy (NCT) compared to those treated with surgery first. We characterize the clinical course and predictive features of salvage treatment for LRR after breast conserving therapy (BCT) analyzed by initial treatment. METHODS: We identified 1,589 patients who underwent BCT; 1,141 (72 %) patients underwent initial surgery, and 448 (28 %) received NCT. Kaplan-Meier and Cox regression analyses were performed to analyze factors associated with overall survival (OS), local control (LC) of recurrence, and distant metastasis-free survival (DMFS) following LRR. RESULTS: 56 patients had a LRR, for a crude recurrence rate of 3 %. For patients with potentially curable recurrence (excluding distant metastases within 3 months of LRR), the 5-year OS, LC, and DMFS rates were 52, 77, and 69 %. On multivariate analysis, initial pathologically negative node status and use of surgery for salvage were significant factors associated with higher OS. Additionally, older age was associated with higher LC rates after salvage. Estrogen receptor-positive disease and surgery for LRR were associated with reduced risk of distant metastases; regional recurrence and use of initial adjuvant chemotherapy were associated with increased risk of distant metastases. For each of these endpoints, the addition of NCT to the multivariate model did not approach significance. CONCLUSIONS: LRR is an uncommon event after BCT and many patients with LRR remain curable (5-year OS >50 %). Our data indicate that NCT does not compromise salvage after LRR, providing further assurance that this strategy is safe for appropriately selected breast cancer patients.

Problematic screen media use in children and adolescents attending child and adolescent psychiatric services in a tertiary care center in North India.

Objective: The present clinic-based study aimed to evaluate screen media use among children and adolescents who had a mental disorder. Methods: Two hundred twelve parents of children and adolescents attending the child and adolescent psychiatric services were approached. They were asked to rate the screen media use of their child brought for psychiatric consultation using the Problematic Media Use Measure-Short Form (PMUM-SF). The DSM-5 criteria of internet gaming disorder (IGD) were applied using the PMUM-SF, which contained nine items equivalent to nine items of IGD. Results: The mean age of the patients was 13.16 years (SD: 4.06; range: 0.8-18). Only 28.3% (n = 60) were aged less than 12 years. The most common primary diagnosis was neurodevelopment disorder (n = 82; 38.7%), followed by neurotic disorder (n = 62; 29.2%) and mood disorder (n = 30; 14.2%). The most common screen media used was television (n = 121; 57.1%) followed by the mobile phone (n = 81; 38.2%). The average screen time was 3.14 hours, with a range of 0.5-7 hours, and more than two-third of children and adolescents used screen gadgets for more than the recommended duration. Slightly more than one-fourth (22.2%) of children and adolescents with mental disorders fulfilled the DSM-5 criteria of IGD. When those with and without screen media addiction were compared, those with screen media addiction were more often male, from joint or extended families, more often diagnosed with neurodevelopmental disorders and disruptive disorder, and were less often diagnosed with neurotic disorders. Conclusion: About one-fourth of the children and adolescents with mental disorders had screen media addiction, and two-thirds of them used screen media for more than the recommended duration.

Prospective assessment of mental and physical health of maternal near-miss women: A low-middle-income country's experience.

Background: Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim: A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods: The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist - Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results: The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion: There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.

American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns.

INTRODUCTION: The ACOSOG Z0011 trial has been described as practice-changing. The goal of this study was to determine the impact of the trial on surgeon practice patterns at our institution. METHODS: This is a review of practice patterns comparing the year before release of Z0011 to the year after an institutional multidisciplinary meeting discussing the results. Patients meeting Z0011 inclusion criteria were identified. Clinicopathologic data were compared between the cohorts. RESULTS: There were 658 patients with clinical T1-2 tumors planned for breast conservation: 335 in the pre-Z0011 cohort and 323 post-Z0011. Sixty-two (19 %) patients were sentinel lymph node (SLN) positive in the pre-Z0011 group versus 42 (13 %) post-Z0011 (p = 0.06). Before Z0011, 85 % (53/62) of SLN-positive patients underwent axillary node dissection (ALND) versus 24 % (10/42) after Z0011 (p < 0.001). After Z0011, surgeons were more likely to perform ALND on patients with larger tumors (2.2 vs. 1.5 cm, p = 0.09), lobular histology (p = 0.01), fewer SLNs (1 vs. 3, p = 0.09), larger SLN metastasis size (4 vs. 2.5 mm, p = 0.19), extranodal extension present (20 vs. 6 %, p = 0.16), or a higher probability of positive non-SLNs (p = 0.03). Surgeons were less likely to perform intraoperative nodal assessment post-Z0011 (26 vs. 69 %, p < 0.001) resulting in decreased median operative times for SLN-negative patients (79 vs. 92 min, p < 0.001). CONCLUSIONS: Surgeons at our institution have implemented Z0011 results for the majority of patients; however, clinicopathologic factors still impact the decision to perform ALND. Z0011 results have significantly impacted practice by decreasing rates of ALND, use of intraoperative nodal evaluation, and operative times.

Olfactory conditioning in the third instar larvae of Drosophila melanogaster using heat shock reinforcement.

Adult Drosophila melanogaster has long been a popular model for learning and memory studies. Now the larval stage of the fruit fly is also being used in an increasing number of classical conditioning studies. In this study, we employed heat shock as a novel negative reinforcement for larvae and obtained high learning scores following just one training trial. We demonstrated heat-shock conditioning in both reciprocal and non-reciprocal paradigms and observed that the time window of association for the odor and heat shock reinforcement is on the order of a few minutes. This is slightly wider than the time window for electroshock conditioning reported in previous studies, possibly due to lingering effects of the high temperature. To test the utility of this simplified assay for the identification of new mutations that disrupt learning, we examined flies carrying mutations in the dnc gene. While the sensitivity to heat shock, as tested by writhing, was similar for wild type and dnc homozygotes, dnc mutations strongly diminished learning. We confirmed that the learning defect in dnc flies was indeed due to mutation in the dnc gene using non-complementation analysis. Given that heat shock has not been employed as a reinforcement for larvae in the past, we explored learning as a function of heat shock intensity and found that optimal learning occurred around 41 °C, with higher and lower temperatures both resulting in lower learning scores. In summary, we have developed a very simple, robust paradigm of learning in fruit fly larvae using heat shock reinforcement.

Home-based telemental health services for Indian patients during the COVID-19 pandemic: A comparison with the pre-COVID phase.

Background: Many developed countries have switched from conventional outpatient psychiatric services to tele mental health-based alternatives because of the COVID-19 pandemic. However, similar transitions might be difficult for countries like India because of a shortage of necessary resources. Therefore, the feasibility and acceptability of converting to a home-based tele mental health (HB-TMH) service during the pandemic were examined in an Indian hospital. Materials and Methods: A new and expanded version of an HB-TMH service was operated for all outpatients following the onset of the pandemic. Feasibility outcomes included operational viability, service utilization, service engagement, the need for additional in-person services, and the frequency of adverse events. Patients' and clinicians' satisfaction with different aspects of the service were evaluated using Likert-style questionnaires to ascertain acceptability. The outcomes during the prepandemic and pandemic phases were also compared. Results: The switch to HB-TMH services took 6 weeks during the pandemic. Patient numbers increased greatly following this transition. Attendance improved, the requirement for in-person services was low, and no serious adverse events were reported. However, patients' satisfaction levels were relatively low during the pandemic. Clinicians were more satisfied than the patients with HB-TMH treatment during the pandemic. Differences between them were less marked but still present before the pandemic. Pre- and postpandemic comparisons revealed that both patients and clinicians were more satisfied with all aspects of HB-TMH care before the pandemic than during it. Conclusions: Though conversion to HB-TMH services was feasible during the pandemic, such services need to be improved to enhance patient acceptability.

Is the temperamental trait of high persistence protective in siblings? - A comparative, exploratory study of healthy siblings, and attention deficit hyperactivity disorder probands.

Background: Study of temperament in first-degree relatives is an important line of inquiry to substantiate temperament as an etiological marker. Aim: This study aims to compare temperament in children with attention deficit hyperactivity disorder (ADHD) and their healthy siblings and to assess the association between ADHD symptoms and temperament dimensions in healthy siblings. Settings and Design: The study was carried out in the outpatient department of psychiatry in a tertiary care teaching hospital. A cross-sectional design with nonprobabilistic sampling technique was used for data collection. Materials and Methods: A hundred children (50 children with ADHD and 50 siblings-one for each child with ADHD) were assessed retrospectively on temperament measurement schedule (TMS) and conners parent rating scale-revised: short form (CPRS-R: S). Statistical Analysis: IBM SPSS Statistics for Windows, Version 20.0 was used for statistical analysis. Mean and standard deviation and frequency and percentage were computed for continuous and categorical variables, respectively. Student's t-test was computed to compare means of the two groups and regression analysis was computed to see for the variance in ADHD subscale scores explained by temperament scores on TMS. Results: Siblings scored highest on the intensity of reaction and lowest on threshold of responsiveness. Compared to probands, siblings scored significantly higher on persistence and lower on activity level, even after controlling for gender. Persistence trait had a significant negative correlation with and explained 7.4% to 21% of variance of all CPRS-R: S subscales. Persistence and distractibility together explained 23.2% of inattention scores. Conclusion: Higher persistence in siblings appears to offer protection to these at-risk individuals who do not have ADHD; favoring the dual pathway model of ADHD.

Play Therapy via Telemedicine in a Child with Sudden-onset Emotional Disorder During the COVID-19 Lockdown Period: A Case Report.

The mental health of children and adolescents has been significantly affected by the COVID-19 pandemic, and recent data suggests there had been an upsurge of psychiatric morbidity in this subgroup of population. Nonpharmacological behavioral intervention in the form of play therapy has been regarded as one of the best treatment strategies in children with emotional disorders. During lockdown, we attempted a play therapy via telemedicine. In this case report, we describe the case of a four-year-old girl who had sudden-onset behavioral problems following an unplanned hair cut during the lockdown, which was managed with teleplay therapy.

Contribution of spirituality to quality of life in patients with residual schizophrenia.

There is increasing recognition that a person's spiritual or religious experiences contribute to quality of life (QOL). However, research exploring the relation between spirituality and QOL has mainly been in the context of chronic and life-threatening illnesses, and studies examining this important correlate of QOL in chronically mentally ill subjects are sparse. This study aimed to explore the relationship between spirituality and QOL, and to investigate if spirituality contributes to other domains of QOL (both physical and psycho-social) in subjects with residual schizophrenia. In a study with a cross-sectional design, 103 patients with residual schizophrenia were assessed with the Positive and Negative Syndrome scale, and their quality of life, spirituality and religiousness were assessed with the WHO Quality of Life-Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB) scale. The SRPB domain and all its facets other than spiritual connection correlated significantly with all other domains of QOL and overall QOL. On regression analysis, the inner peace domain of spirituality explained 21.6 to 37.6% of variance of all QOL domains except the domain of level of independence. The spirituality domain explained 33.8% of the variance of the 'level of independence domain of QOL. Taken together, inner peace and spirituality facets explained 23 to 40% of the variance of the social relationships domain, the psychological domain and the level of independence domain of QOL. This study suggests that spirituality and religiosity have an important influence on overall QOL of patients with schizophrenia. Hence, besides pharmacological and non-pharmacological management for schizophrenia, clinicians should focus on this aspect and encourage their patients to follow their religious practices and spiritual beliefs.

Relationship between spirituality/religiousness and coping in patients with residual schizophrenia.

PURPOSE: To measure spirituality/religiousness and its relation to coping skills in patients with residual schizophrenia. METHODS: Using a cross-sectional design, 103 persons with residual schizophrenia were assessed on Positive and Negative Syndrome Scale [PANSS] and Ways of Coping Checklist [WCC] to assess the repertoire of coping skills and WHO Quality of Life-Spirituality, Religiousness and Personal Belief scale [WHOQOL-SRPB] to assess religiousness and spirituality. RESULTS: Positive reappraisal as a coping strategy had significant positive correlation with all the facets of WHOQOL-SRPB and SRPB total domain scores. The coping subscales of accepting responsibility, planful problem solving, distancing, confrontive coping, and self-controlling also had significant positive correlations with different facets of WHOQOL-SRPB and total SRPB domain score. Seeking social support and escape-avoidance as coping mechanisms had no correlations with any of the WHOQOL-SRPB facets. CONCLUSIONS: A sound spiritual, religious, or personal belief system is associated with active and adaptive coping skills in subjects with residual schizophrenia. Understanding and assessing the spirituality and religiousness of subjects with schizophrenia can help in better management of the disorder.

Use of modified electroconvulsive therapy in a case of polymyositis presenting with delusion of nihilism of proxy (Odysseus syndrome).

We present a case of psychotic depression with polymyositis presenting with the distinct phenomenon of nihilism by proxy, which was treated with electroconvulsive therapy (ECT). A female patient with polymyositis was initially treated with pharmacotherapy. After initial response, there was deterioration in her mental state and hence, after careful consideration, neurological, and anaesthetic consultations, modified ECT was given with close monitoring. The mental state of the patient improved with a course of ECT, which proceeded without any complications. Her depressive symptoms including the delusion of nihilism by proxy responded to ECT. To the best of our knowledge, the use of ECT has not been reported in a case of polymyositis before, and this case shows that modified ECT can be given successfully in patients with polymyositis.

Impact of COVID-19 and Lockdown on Children with ADHD and Their Families-An Online Survey and a Continuity Care Model.

Background Little is known about the impact of the coronavirus disease 2019 pandemic on children with attention-deficit hyperkinetic disorder (ADHD). This study aimed to assess the impact of lockdown on children with the ADHD, and their families. Additionally, feasibility of carrying out "text message-based" intervention was evaluated. Methods An online survey was performed to evaluate the impact of lockdown on children with ADHD and their family members. Additionally, a "text message"-based intervention was performed over 2 weeks. Along with the text-based intervention, we also provided reading materials and an option of telephonic consultation. Results Of the 80 parents who initially consented to participate, 48 filled the baseline survey, and 41 agreed to receive intervention. Out of 41, 29 filled satisfaction survey. During the lockdown period, there was worsening of symptoms of ADHD in the form of increase (slight or marked) in the activity level (50.1%), irritability (45.8%), and disturbing or disruptive behavior (47.7%) in children. In terms of behavior of family members, there was marked/slight increase in irritability (37.5%), and shouting at the child (43.8%), verbal abuse (25%), and punishing the child (27.1%). Additionally, there was an increase in the praising (67.6%) and spending time with the child (72.9%). Text-based messages on a scale of 0 to 10 were rated as 5.79 for the content, 5.76 for the usefulness, and 6 for satisfaction. Conclusion Lockdown resulted in worsening of symptoms among children of ADHD and it had impact on the interaction pattern of the children and parents. A "text message"-based intervention is a feasible and possibly acceptable option to deal with the behavioral problem of the children and adolescents with ADHD.

Development and effectiveness of parent skills training intervention for Indian families having children with attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE: Parent skills training interventions (PSTIs) are considered first-line treatment for ADHD. We describe development and effectiveness of a culturally-contextualised PSTI for Indian families. METHOD: Forty-one families divided into 5 groups, each group with 6-10 families received group PSTI comprising of 10 weekly sessions using multi-point videoconferencing as an adjunct to routine care in the non-randomized pre-post intervention study. RESULTS: Thirty-six families attended more than 3 sessions. RM ANOVA revealed significant improvements in parent-rated measures of inattention (p < 0.001), hyperactivity/ impulsivity (p = 0.007), conduct problems (p = 0.002), academic performance (p = 0.001) and classroom behavior (p = 0.001). Mixed ANOVA analysis did not reveal significant differences between those who received PSTI with medication and those who received PSTI on any VADPRS domains except depression/ anxiety scores, wherein former group performed better (p = 0.008). More than 60 % parents perceived that PSTI was helpful in increasing awareness, reducing guilt/ blame, improving parent-child relation and decreasing stress. Difficulty in sustaining with the strategies was reported by 50 % of parents. CONCLUSION: Findings suggest that PSTI is effective and helpful for Indian families dealing with ADHD.

Use of Electroconvulsive Therapy in Adolescents: A Retrospective Study.

BACKGROUND: This study aimed to evaluate the clinical profile of adolescents aged up to 19 years who had received electroconvulsive therapy (ECT). METHODS: A retrospective chart review was carried out to identify adolescents aged up to 19 years who had received ECT during the period 2012-2018. Details regarding their sociodemographic and clinical variables and ECT data were extracted from the records. RESULTS: During the study period, a total of 51 adolescents received ECT, and complete records of 50 patients were available for analysis. 4.04% (51 out of 1260) of the patients who received ECT were aged up to 19 years. There was a decreasing trend of use of ECT over the years. The most common diagnosis was schizophrenia (42%), and this was followed by bipolar disorder (22%) and unipolar depression (20%). The mean number of ECTs administered per patient was 8.84 (SD: 5.34; range: 1-21). On the various rating scales, the percentage improvement in patients with psychotic disorders was 77.4%. For patients with depression, the percentage improvement was 77.2%, and that for mania was 80.3%. The percentage improvement in organic catatonia was 64.6%. The number of patients achieving ≥50% response ranged from 87.5% to 100%, and when the response was defined as ≥75% improvement, the proportion of patients varied from 50% to 76.9%. The majority of patients with depression (72.7%) and mania (77.8%) achieved remission. Immediate complications associated with the use of ECT included acute blood pressure changes (18%).