The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients.

COVID-19 is a viral infection that has multisystemic physical and psychological complications. The following paper looks at the various challenges seen while treating psychiatric patients during the COVID pandemic. There is a need for physician to be aware of the drug interactions between psychiatric medications and the medications used routinely in the management of COVID. There is also the concern of psychiatric side effects of medications used to manage COVID and medical complications caused by some side effects of psychiatric drugs. The telepsychiatry and telemedicine paradigm has made it mandatory for physicians to be vigilant of the same.

Phase transition and thermal expansion studies of alumina thin films prepared by reactive pulsed laser deposition.

Aluminium oxide (Al2O3) thin films were deposited on Si (100) substrates at an optimized oxygen partial pressure of 3 x 10(-3) mbar at room temperature by pulsed laser deposition (PLD). The films were characterized by high temperature X-ray diffraction (HTXRD), field emission scanning electron microscopy (FESEM) and atomic force microscopy (AFM). The HTXRD pattern showed the cubic y-Al2O3 phase in the temperature range 300-973 K. At temperatures ≥ 1073 K, the δ and θ-phases of Al2O3 were observed. The mean linear thermal expansion coefficient and volume thermal expansion coefficient of γ-Al2O3 was found to be 12.66 x 10(-6) K(-1) and 38.87 x 10(-6) K(-1) in the temperature range 300 K-1073 K. The field emission scanning electron microscopy revealed a smooth and structureless morphology of the films deposited on Si (100). The atomic force microscopy study indicated the increased crystallinity and surface roughness of the films after annealing at high temperature.

Development of a CrN/Cu nanocomposite coating on titanium-modified stainless steel for antibacterial activity against Pseudomonas aeruginosa.

A relatively simple method was developed to fabricate CrN/Cu nanocomposite coatings using pulsed DC magnetron sputtering for application in antibacterial activity. These nanocomposite coatings were applied on titanium (Ti)-modified stainless steel substrata (D-9 alloy) and the antibacterial activity of these coating with respect to the Gram-negative bacterium Pseudomonas aeruginosa was investigated qualitatively and quantitatively. Scanning electron microscopy, epifluorescence microscope analyses, and total viable counts confirmed that inclusion of copper in the CrN/Cu nanocomposite coatings provided antibacterial activity against P. aeruginosa. The quantitative examination of the bacterial activity of P. aeruginosa was estimated by the survival ratio as calculated from the number of viable cells which formed colonies on nutrient agar plates.

Psychological interventions during COVID-19: Challenges for low and middle income countries.

At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from China has spread to the world. There have been increasing numbers of confirmed cases and deaths around the globe. The COVID-19 pandemic has paved the way for considerable psychological and psychosocial morbidity among the general public and health care providers. An array of guidelines has been put forward by multiple agencies for combating mental health challenges. This paper addresses some of the mental health challenges faced by low and middle income countries (LMIC). It is worthwhile to note that these are challenges at the current stage of the pandemic and may change with the course of the pandemic itself.

X-ray diffraction study of nanocrystalline titania thin films prepared by pulsed laser deposition.

Pulsed laser deposition of phase pure thin films of rutile and anatase from a rutile target is investigated. Rutile films prepared at the base pressure and at < or =473 K were amorphous and the crystalline quality was improved with increasing substrate temperature. The crystallite size was found to vary from 2 nm to 58 nm in the temperature range 573-973 K. Addition of oxygen has been found to be beneficial in promoting the formation of anatase phase even at a temperature of 673 K. From the base pressure to 10(-4) mbar, films were rutile, while at approximately 0.001 mbar, the rutile phase was found to transform to anatase. Rietveld analysis indicated about 20% of anatase and about 80% of rutile phase for the films prepared at 0.001 mbar of oxygen partial pressure. Good quality anatase films were formed at approximately 0.05 mbar, while the films were amorphous at higher partial pressures of oxygen.

Synthesis and properties of ceria thin films prepared by pulsed laser deposition.

Cerium oxide (CeO2) thin films were prepared on (100) Si and glass substrates using pulsed laser ablation at different oxygen partial pressures (2.5 x 10(-5)-3.5 x 10(-1) mbar) and at a substrate temperature of 873 K. XRD studies on the films showed that the films are polycrystalline having fluorite structure. The oxygen partial pressure has a dominant effect on the thickness, crystallite size and preferred orientation of the films. At an oxygen partial pressure of 3.5 x 10(-2) mbar, the intensity of (200) reflection is maximum and film possesses the maximum crystallite size of about 50 nm. Though all the films are highly transparent in the visible region, films prepared at an oxygen partial pressure of 3.5 x 10(-1) mbar, exhibits maximum transmittance (>90% @ 632 nm). The optical band gap is found to decrease from 3.66 to 3.42 eV with the increasing oxygen partial pressure.

A study on the influence of copper content in CrN/Cu nanocomposite thin films prepared by pulsed DC magnetron sputtering.

Synthesis of nanocomposite thin films of CrN/Cu deposited on (100) Si and D-9 alloy substrates by pulsed magnetron sputtering as a function of copper content in the range 15.1-35.8 at.% is investigated. XRD analysis of the films deposited at 773 K with nitrogen flow rate of 10 sccm indicated that the films are nanorystalline and bi-phasic (fcc-CrN and fcc-Cu). Scanning electron microscopy showed a structureless morphology for CrN, while agglomerates were obtained for CrN/Cu nanocomposite thin films. Atomic force microscopy also confirmed the agglomeration of particles with increasing Cu content. The amount of copper content in the nanocomposite films had also shown a significant reduction in the crystallite size of CrN. The nano hardness measurements showed a peak hardness of 17 GPa for the films with copper content of 15.1 at.%. The hardness values were found to decrease significantly with Cu content > 31.1 at.%.

Microstructural studies of nanocomposite thin films of Ni/CrN prepared by reactive magnetron sputtering.

Synthesis and characterization of nanocomposites of Ni/CrN thin films prepared by DC magnetron sputtering from a target of 50 wt.%Ni-50 wt.%Cr is investigated. The films prepared as a function of nitrogen flow rate and substrate temperature showed that the films contained Ni and CrN phases with crystallite sizes in the nanometer range. Measurement of nanomechanical properties of the composite films exhibited a significant decrease in the values of hardness and Young's modulus than those of pure CrN films.

Indian guidelines on neurosurgical interventions in psychiatric disorders.

Neurosurgery for psychiatric disorders (NPD) has been practiced for >80 years. However, the interests have waxed and waned, from 1000s of surgeries in 1940-1950s to handful of surgery in 60-80s. This changed with the application of deep brain stimulation surgery, a surgery, considered to be "reversible" there has been a resurgence in interest. The Indian society for stereotactic and functional neurosurgery (ISSFN) and the world society for stereotactic and functional neurosurgery took the note of the past experiences and decided to form the guidelines for NPD. In 2011, an international task force was formed to develop the guidelines, which got published in 2013. In 2018, eminent psychiatrists from India, functional neurosurgeon representing The Neuromodulation Society and ISSFN came-together to deliberate on the current status, need, and legal aspects of NPD. In May 2018, Mental Health Act also came in to force in India, which had laid down the requirements to be fulfilled for NPD. In light of this after taking inputs from all stakeholders and review of the literature, the group has proposed the guidelines for NPD that can help to steer these surgery and its progress in India.

Transmission electron microscopy studies and modeling of 3D reciprocal space of ω forming alloy.

Initial stage of ω phase formation and associated anomalous features that appear in diffraction patterns of a metastable ß transition metal alloy have been investigated in this study with the aid of transmission electron microscopy, simulation and modeling. The paper explores discrete features that emerge in selected area diffraction patterns of quenched Ti-15wt%Mo alloy and analyzes the correlation between ω reflections and diffuse arcs by considering all variants of ω phase as per the formation kinetics of ω phase in ß matrix while quenching. Superimposed simulated diffraction patterns have been compared with experimental counterparts and it is deduced that there is lack of congruence between ω reflections and diffuse arcs even after considering trigonal ω with varying degrees of displacement. Direct lattice imaging of trigonal ω in ß matrix has been demonstrated by phase contrast microscopy coupled with Fourier filtering techniques. By investigating the nature of ω reflections and diffuse arcs with the aid of electron diffraction pattern calculations and phase contrast microscopy, it is shown that, existing model of three-dimensional (3D) reciprocal space of ω forming alloy at quenched stage is not complete. A new model incorporating a patterned intensity distribution is fitted at the octahedral sites of an fcc reciprocal lattice whose planar intersections with Ewald's sphere show a better fit with the observed experimental diffraction patterns.

Management of obsessive-compulsive disorder comorbid with bipolar disorder.

Obsessive-compulsive disorder (OCD) is one of the most common comorbidities in bipolar disorder (BD). Clinicians often get perplexed in making treatment decisions when encountering comorbid OCD and BD as treatment of OCD by pharmacotherapy may induce or exacerbate mood instability and psychotherapeutic approaches for OCD may not be feasible in acute manic or depressive state of BD. In this study, we reviewed literature, whether existing guideline-based treatments of BD may be effective in OCD and whether newer agents will be of use for treating this comorbidity. We could find that treatment of such comorbid disorder is largely understudied. Adjuvant topiramate or olanzapine- selective serotonin reuptake inhibitor/clomipramine combination along with mood stabilizer is found to be effective for treating OCD in BD. Use of other conventional pharmacological agents and psychotherapy for treating comorbid OCD in BD lacks evidence and is limited to case reports. Our review also highlights the need for further studies regarding the treatment strategies in this highly prevalent comorbid disorder.

Cognitive remediation in schizophrenia-The view from India.

The prevalence and disability due to Schizophrenia (SZ) in India is similar to other parts of the world. Cognitive impairments are also present in a large group of Indian persons with SZ. Interventions to address these impairments - termed cognitive remediation or cognitive retraining - are being tested all over the world. Indian research on remediation in schizophrenia has been eclectic and is reviewed here. Some investigators have focused mainly on symptom control and quality of life, as yoga could be a cost effective and culturally acceptable intervention for remediation and rehabilitation. Although participants were not exhaustively tested for improvement in cognitive function in the majority of such trials, published results are encouraging.

Role of Donepezil in the Management of Neuropsychiatric Symptoms in Alzheimer's Disease and Dementia with Lewy Bodies.

Alzheimer's disease (AD) is a progressive condition that affects cognition, function, and behavior. Approximately 60-90% of patients with AD develop neuropsychiatric symptoms (NPS) such as hallucinations, delusions, agitation/aggression, dysphoria/depression, anxiety, irritability, disinhibition, euphoria, apathy, aberrant motor behavior, sleep disturbances, appetite and eating changes, or altered sexual behavior. These noncognitive behavior changes are thought to result from anatomical and biochemical changes within the brain, and have been linked, in part, to cholinergic deficiency. Cholinesterase inhibitors may reduce the emergence of NPS and have a role in their treatment. These agents may delay initiation of, or reduce the need for, other drugs such as antipsychotics. This article summarizes the effects of donepezil, a cholinesterase inhibitor, on the NPS of dementia with emphasis on AD and dementia with Lewy bodies.

Chloroquine psychosis: a chemical psychosis?

Psychotic states are mimicked by the use of many drugs including amphetamines, cannabis, lysergic acid diethylamide, psilocybin, mescaline, isoniazid, and L-dopa. A paranoid psychotic picture in a clear sensorium is characteristic of amphetamine psychosis. In developing countries, malaria among other diseases is a frequent indicator of chloroquine administration. The present communication reports a series of chloroquine-induced psychosis in a clear sensorium simulating affective illness, such as mania, mixed affective states, or depression. The psychosis disappeared after cessation of the drug, combined with or without the use of low dosage phenothiazines in excited patients. From our cases, two types of presentation of chloroquine psychosis could be seen: (1) psychic with clear sensorium, mood changes, alteration in motor activity, delusions, and hallucinations; and (2) psycho-organic with clouded sensorium, disorientation, and fleeting hallucinations. The precise nature of the mechanism of the psychosis is not clear because of the limited number of reported cases.

A double blind randomised comparison of chlordiazepoxide and lorazepam in alcohol withdrawal.

AIM: To compare the efficacy of lorazepam and chlordiazepoxide in alcohol withdrawal in a double blind design. METHODS: The study sample consisted of 108 consecutive admissions to the de addiction ward, which after informed consent and selection based on inclusion criteria, were randomised to two groups. A comparison of the efficacy of chlordiazepoxide and lorazepam was done post randomisation. The initial withdrawal assessment and subsequent progress of withdrawal were assessed using Clinical Institute Assessment for Alcohol-revised (CIWA-Ar). The rate of withdrawal and total duration of withdrawal were compared among the two groups. RESULTS: Lorazepam treated group showed a significant difference in the rate of improvement over 48 h compared to chlordiazepoxide group (70.4% vs. 54.8%; p=0.000). The total duration of withdrawal was also significantly lesser with lorazepam (5.6 days vs. 6.7 days; p=0.001). CONCLUSION: Lorazepam is more effective than chlordiazepoxide in alcohol withdrawal in both a faster rate in the drop of withdrawal severity and lessening the total duration of withdrawal.

Position statement and guidelines on unmodified electroconvulsive therapy.

BACKGROUND: In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well. MATERIALS AND METHODS: This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks. RESULTS: Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility. CONCLUSIONS: Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document).

Frontotemporal dementia: An updated overview.

Frontotemporal dementia (FTD) is a progressive neurodegenerative syndrome occurring between 45 and 65 years. The syndrome is also called frontotemporal lobar degeneration (FTLD). However, FTLD refers to a larger group of disorders FTD being one of its subgroups. The other subgroups of FTLD are progressive nonfluent aphasia (PFNA), and semantic dementia (SD). FTLD is characterized by atrophy of prefrontal and anterior temporal cortices. FTD occurs in 5-15% of patients with dementia and it is the third most common degenerative dementia. FTD occurs with equal frequency in both sexes. The age of onset is usually between 45 and 65 years though it may range anywhere from 21 to 81 years. The usual course is one of progressive clinicopathological deterioration with mortality within 6-8 years. Unlike Alzheimer's disease (AD), this condition has a strong genetic basis and family history of FTD is seen in 40-50% of cases. FTD is a genetically complex disorder inherited as an autosomal dominant trait with high penetrance in majority of cases. Genetic linkage studies have revealed FTLD loci on chromosome 3p, 9, 9p, and 17q. The most prevalent genes are PGRN (progranulin) and MAPT (microtubule-associated protein tau), both located on chromosome 17q21. More than 15 different pathologies can underlie FTD and related disorders and it has four major types of pathological features: (1) microvacuolation without neuronal inclusions, (2) microvacuolation with ubiquitinated rounded intraneuronal inclusions and dystrophic neurites FTLD-ubiquitinated (FTLD-U), (3) transcortical gliosis with tau-reactive rounded intraneuronal inclusions, (4) microvacuolation and taupositive neurofibrillary tangles. Behavior changes are the most common initial symptom of FTD (62%), whereas speech and language problems are most common in NFPA (100%) and SD (58%). There are no approved drugs for the management of FTD and trials are needed to find effective agents. Non-pharmacological treatment and caregiver training are important in the management of FTD.

Neurobiology of Alzheimer's disease.

Alzheimer's disease (AD) is a devastating neurodegenerative disease, the most common among the dementing illnesses. The neuropathological hallmarks of AD include extracellular beta-amyloid (amyloid precursor protein (APP) deposits, intracellular neurofibrillary tangles (NFT)), dystrophic neuritis and amyloid angiopathy. The mismetabolism of APP and the defective clearance of beta amyloid generate a cascade of events including hyperphosphorylated tau (tau) mediated breakdown of microtubular assembly and resultant synaptic failure which results in AD. The exact aetiopathogenesis of AD is still obscure. The preeminent hypotheses of AD include amyloid cascade hypothesis and tau hyperphosphorylation. The amyloid hypothesis states that extracellular amyloid plaques formed by aggregates of Abeta peptide generated by the proteolytic cleavages of APP are central to AD pathology. Intracellular assembly states of the oligomeric and protofibrillar species may facilitate tau hyperphosphorylation, disruption of proteasome and mitochondria function, dysregulation of calcium homeostasis, synaptic failure, and cognitive dysfunction. The tau hypothesis states that excessive or abnormal phosphorylation of tau results in the transformation of normal adult tau into PHF-tau (paired helical filament) and NFTs. Vascular hypothesis is also proposed for AD and it concludes that advancing age and the presence of vascular risk factors create a Critically Attained Threshold of Cerebral Hypoperfusion (CATCH) which leads to cellular and subcellular pathology involving protein synthesis, development of plaques, inflammatory response, and synaptic damage leading to the manifestations of AD. Multiple other aetiological and pathogenetic hypotheses have been put forward including genetics, oxidative stress, dysfunctional calcium homeostasis, hormonal, inflammatory-immunologic, and cell cycle dysregulation with the resultant neurotransmitter dysfunctions and cognitive decline. The available therapeutic agents target only the neurotransmitter dysfunction in AD and agents specifically targeting the pathogenetic mechanisms like amyloid deposition and tau hyperphosphorylation might provide a definite therapeutic edge.

Neurobiology of spirituality.

Spiritual practices have been proposed to have many beneficial effects as far as mental health is concerned. The exact neural basis of these effects is slowly coming to light and different imaging techniques have elucidated the neural basis of meditative practices. The evidence though preliminary and based on studies replete with methodological constraints, points toward the involvement of the prefrontal and parietal cortices. The available data on meditation focus on activated frontal attentional network. Neuroimaging studies have shown that meditation results in an activation of the prefrontal cortex, activation of the thalamus and the inhibitory thalamic reticular nucleus and a resultant functional deafferentation of the parietal lobe. The neurochemical change as a result of meditative practices involves all the major neurotransmitter systems. The neurotransmitter changes contribute to the amelioration of anxiety and depressive symptomatology and in part explain the psychotogenic property of meditation. This overview highlights the involvement of multiple neural structures, the neurophysiological and neurochemical alterations observed in meditative practices.