Study of psychological effects of deployment at extreme high altitude area on soldiers.

BACKGROUND: The Indian Armed Forces are fighting the battle at extreme High Altitude, the most inhospitable terrain in the world, for the last thirty five years. The stress of being isolated under harsh environmental conditions on a daily basis can have an adverse effect on their mind. However, so far, no study has been undertaken to assess the psychological effects of deployment at extreme High Altitude. METHODS: Three hundred thirty-four troops selected for deployment were initially evaluated using the General Health Questionnaire-12 (GHQ-12) and Armed Forces Medical College Life Events Scale (AFMC LES) as screening tools to assess mental health status after obtaining ethical clearance and informed consent. On deinduction after a deployment for more than three months, they were reassessed. The data collected were statistically analysed. RESULTS: As per GHQ-12 evaluation, after the deployment score increased from 0.2574 to 0.9162, but remained lower than the 'caseness' level of 2. Among the 79 troops with a score of 2 and more, the majority were married and had past history of tenures at high-altitude areas. There was statistically significant increase in the AFMC LES scores also on deployment. CONCLUSION: Deployment at extremely high-altitude areas for even three months produces significant psychological morbidity among troops.

Game of thorns: Modern day opium.

With the advent of internet and mobile communication the virtual space of world wide web has become a playground; people plugged in to it at distant horizon completely unfamiliar to each other are players; keyboard, touchpad and joysticks have become the tools of play; webmaster, app developer are self designated referees of the game; while the virtual media is the largest ever spectators in this amphitheatre of the web. More and more youth are getting hooked onto this and are gradually becoming dependent on these games. World Health Organization has recognized this as a diagnosable medical illness and included as Internet Gaming Disorder (IGD) in its International Classification of Diseases (ICD) -11 released in 2018. Various aspects of this problem are discussed in this article.

Sexuality in the 21st century: Leather or rubber? Fetishism explained.

The sexual physical act is related to sexual attraction, sexual fantasy and sexual behaviour. Fetish has been recognised as an attraction to objects with the aim of achieving sexual gratification. There have been historical accounts of fetishism, and the subject has been of significant interest to clinicians especially those who work in the field of managing mental illnesses. There are various types of fetishism. Reported for the first time in the 19th century, the condition is of various subtypes. Of these, fetishistic disorder can be recognised as sexual fantasies, sexual urges and sexual behaviours which cause significant distress or impairment in an individual in social, occupational or other important areas of function. Fetishism may be related to specific body parts, non-living objects or others. In clinical settings, patients with fetishistic disorders are often referred because of having got into trouble with the law. Fetishism needs to be differentiated from paraphilias. Various explanations including psychoanalysis and behavioural theories have been offered to explain the genesis and management of fetishistic disorders. A fetish is attraction to an object. Treatments can include behavioural, cognitive or psychoanalytic strategies. In this review article, a brief overview on the fetish is offered with suggestions for management.

Combat psychiatry: Indian perspective.

Indian Armed Forces have been engaged in various combat duties for long. The adverse effect of prolonged and repetitive deployment of troops in these highly stressful environment leads to many combat stress behaviors as well as misconduct behaviors. Preventing, identifying and managing these disruptive behaviors are an essential part of combat psychiatry within the larger domain of combat medicine. Indian Armed Forces have a well-oiled mechanism to handle these issues and military psychiatrists are deeply engaged in providing holistic mental health care to the esteemed clientele. Relevant issues on this subject are elaborated in the article.

Cross sectional assessment of empathy among undergraduates from a medical college.

BACKGROUND: Empathy is essentially a desirable quality among clinicians and can be developed during medical education. Studies from outside India have shown that higher empathy is related to better competency and choice of specialty may be related to empathy levels in them. Change in empathy levels among undergraduate medical students with progressive training has been often ascribed to reasons such as curriculum content, timing of clinical rotations. Gender differences in empathy levels also vary among different countries. Since many of such factors differ in India there is a need therefore to understand empathy and its correlates among medical students in India. METHOD: A cross sectional study was undertaken in a large medical college among the undergraduates of first, third, fifth, seventh and ninth semesters to measure their empathy levels. The evaluation was done using the Jefferson's Scale for Physician's Empathy- Student version. RESULTS: The study revealed highest empathy at entry level and a significant fall by seventh semester (p = 0.002). Female students had significantly higher empathy levels than male students (p = 0.012) across all semesters. The variance in empathy scores according specialty chosen is not statistically significant (p = 0.2468). CONCLUSION: The progressive decline in empathy levels with years in medical college here is seen much later than in western studies. Female students are more empathetic than male students. The relation of mean empathy scores and choice of specialty is inconclusive and at variance from other studies.

Interaction of media, sexual activity and academic achievement in adolescents.

BACKGROUND: Adolescence is a period when the individual is vulnerable and exposure to sexually implicit/explicit programs on television and internet can influence their sexual behaviour and make them more permissive towards premarital sex, which is known to influence their academic performance. This can be modified by parental discussion on these matters with their children. There have been only few studies from India that have explored such issues therefore this study aimed to explore the impact of television, internet and parental discussion on sexual activity and academic performance. METHODS: This study was conducted in two co-education schools using a self reporting questionnaire administered to students of class IX-XII. This study evaluated the relation of academic performance, exposure to media such as television & internet to sexual activity & academic performance of the students and the role of parental discussion on these. RESULTS: The study sample size was 586. There is no significant association between the number of hours of watching television per day and academic performance as measured by marks in examinations. Significant positive association was found among boys between sexual contact and average score in academics & unsupervised use of internet. In both genders a significant positive association was found between those watching English serials, movies and increased chances of indulging in sexual activity while a negative relation with those watching Cartoons. There is no significant difference in occurrence of sexual contact in those who discussed sexual matters with parents and those who did not. CONCLUSION: This being first of it's kind of study from India and a cross sectional study, further prospective and detailed studies are warranted to delineate the interaction of media, parental discussion, academic performance and sexual activity.

Clinical Equivalence of Trubond® and Ethibond® Braided Polyester Sutures for Valvular Prosthesis Fixation During Aortic or Mitral Valve Replacement: A Single-Blind Randomized Controlled Trial.

Background Paravalvular leak (PVL) following valve replacement is a serious cardiovascular complication that increases morbidity and mortality. Valve replacement with the interrupted suture technique using polyester suture provides adequate tensile strength and reduces the probability of tissue reaction. This study compared the clinical equivalence of Trubond®(Healthium) and Ethibond® (Ethicon, Johnson & Johnson) braided polyester sutures for valvular prosthesis fixation using interrupted suturing, with respect to the proportion of subjects having PVL after aortic valve (AV) or mitral valve (MV) replacement. Methodology Patients undergoing AV/MV replacement were enrolled and randomized in this study. The primary endpoint of this prospective, multicentric, two-arm, randomized (1:1), parallel-group, single-blind study (December 2020-October 2022) was the presence of PVL in Trubond® (n = 40) and Ethibond® (n = 42) groups within 26 weeks of surgery. The secondary endpoints included event rate of all-cause mortality, cardiac death, stroke, myocardial infarction, re-hospitalization, re-intervention, wound infection, operative time, intraoperative suture parameters, postoperative hospital stay, time to resume normal activities and work, quality of life, patient satisfaction, and adverse events in both groups. Results Patients who underwent AV/MV replacement and were followed up until 26 weeks had no incidence of PVL or other postoperative complications. No requirement for readmission or re-intervention was noted in both groups. Intraoperative suture handling characteristics, operative time, and hospital stay were also comparable between the groups. With each follow-up, subjects in both groups exhibited improved postoperative functional abilities, quality of life, and health status. Conclusions Trubond® braided polyester suture is clinically equivalent to Ethibond® braided polyester suture. Trubond® suture is safe and effective for valvular prosthesis fixation in patients undergoing AV or MV replacement.

Neurocognitive impairment in alcohol-dependence syndrome cases and its response to treatment.

BACKGROUND: A sizeable portion of psychiatric ward beds in military hospitals is occupied by patients with psychoactive substance abuse and especially by alcohol-dependence syndrome (ADS) cases. Though there have been significant advances in the diagnosis and management of these cases, not much of work has been done in our set up for the evaluation of their cognitive impairment and its response to treatment. METHODS: Neuropsychological evaluation of 100 cases of freshly diagnosed ADS was done by using postgraduate battery of brain dysfunction (PGI-BBD). The findings were compared with controls. They were detoxified, treated and after four weeks were re-evaluated and the findings were analysed. RESULTS: There was significant impairment in all parameters of cognition. All of them showed improvement with treatment but after four weeks, the impairment persisted to significant level in some parameters. CONCLUSION: Alcohol-dependence syndrome cases have significant cognitive impairment but improve with detoxification, multivitamin supplement and abstinence. This aspect has to be kept in mind while deploying them in sensitive appointments.

Association of sociodemographic factors with various domains of alcohol-induced sexual dysfunction - An Indian perspective.

BACKGROUND: Sexual dysfunction is frequently seen in alcohol-use disorders. The available research on this topic has studied erectile dysfunction and premature ejaculation using nonvalidated scales. This study was undertaken to study the other major domains of sexual dysfunction, namely sexual desire, orgasmic dysfunction and satisfaction, and their association with sociodemographic factors. MATERIALS AND METHODS: A cross-sectional descriptive study design was used and 78 male patients were recruited. The assessment was conducted using a specially designed intake pro forma, International Index of Erectile Function (IIEF-15) Scale, DSM-5 and International Classification of Disease, 10th revision, diagnostic criteria for research. A correlation between the amount of alcohol consumed and its effect on various domains of sexual dysfunction was also carried out using Pearson's correlation coefficient. RESULTS: The sociodemographic profile was studied in association with the overall (total) IIEF-15 subscale using analysis of variance (ANOVA). Statistically significant differences were observed among age groups, education subgroups, marital disharmony, years of alcohol use, and lifetime alcohol use. Further, since the values of ANOVA were significant, Tukey's post hoc analysis was carried out which showed a statistically significant difference among the groups. Various domains of sexual dysfunction showed a strongly negative correlation for overall IIEF subscale followed by intercourse satisfaction, sexual desire, and orgasmic function with years of alcohol use and lifetime alcohol use. CONCLUSION: Sexual dysfunction in alcohol dependence patients was significantly associated with a family history of paternal alcohol abuse, lower educational background, increasing age, and marital disharmony. This study also found a strongly negative correlation between various domains of sexual functioning and years of alcohol use/lifetime alcohol use.

Transcranial magnetic stimulation: A review of its evolution and current applications.

Repetitive transcranial magnetic stimulation (rTMS) is a recently developed noninvasive brain stimulation method for the treatment of psychiatric and neurological disorders. Although, its exact mechanism of action is still not clear, current evidence points toward its role in causing long-term inhibition and excitation of neurons in certain brain areas. As evidence steadily grows in favor of rTMS as a therapeutic tool; there is a need to develop standardized protocols for its administration. There have been no reports of any serious side effects with rTMS, though its use is restricted in those having magnetic implants or recent adverse neurological or cardiac event. Of all the psychiatric indications of rTMS, the evidence is most robust for treatment of refractory unipolar depression. This paper reviews contemporary literature highlighting the evolution of rTMS as a diagnostic and therapeutic tool, especially in the management of treatment-resistant depression.

Dental Health Requirements for Psychiatric Patients.

BACKGROUND: This study was conducted to assess the dental treatment requirements of psychiatric patients in comparison with the non psychiatric patients admitted in the hospital. METHODS: A total of 103 hospitalised psychiatric patients were examined with an equal number of non psychiatric hospitalized patients. RESULT: 73.22 % of psychiatric patients exhibited higher caries index along with higher decayed missing filled teeth (DMFT) as compared to 68.31 % in the control group. The incidence of periodontal diseases were significantly higher among the study group than the controls. There were statistically significant correlation between smoking, family pattern, calculus index and gingival index amongst psychiatric patients. CONCLUSION: There was a higher incidence of caries index, missing teeth and less filled teeth among psychiatric patients, indicating extensive dental treatment requirement for this group.

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.

The study of primary psychotic disorders with concurrent substance abuse in terms of their diagnostic stability.

BACKGROUND: Co-morbid substance use is common among individuals presenting with symptoms of psychosis. There is a paucity of research in this area. AIM: To study the longitudinal follow-up of patients over 1-year of first episode psychosis with concurrent substance use in terms of their diagnostic stability. MATERIALS AND METHODS: Fifty patients having at least one symptom of psychosis at first admission at a General Hospital Psychiatric Unit along with concurrent substance abuse were included and followed up for 1-year. International Classification of Disease-10, diagnostic criteria were used for diagnosis. Semi-structured sociodemographic performa to assess the sociodemographic profile. Brief Psychiatric Rating Scale and Alcohol Use Disorder Identification Test as rating scales were used for the assessment at 6 and 12 months. RESULTS: Of 50 patients, 31 patients who had a diagnosis of primary psychosis retained their diagnosis at follow-up. The mean age of cases in substance-induced psychosis group was 37.47 years, which was significantly higher than in primary psychosis group at 31.52 years. However, 7 patients of the substance-induced psychosis group required a change in diagnosis to primary psychosis group. The primary psychosis group patients were significantly younger, less educated, had less family support, had greater family mental illness, had more severe symptoms, and less hallucinations. CONCLUSION: The present study is a forerunner in this area. Salient differences indicated in the study can help in differentiating the diagnosis and in the management of cases. This is particularly relevant in the management setting and for long-term intervention purpose.

A case of Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.

Classification of cardiac abnormalities using heart rate signals.

The heart rate is a non-stationary signal, and its variation can contain indicators of current disease or warnings about impending cardiac diseases. The indicators can be present at all times or can occur at random, during certain intervals of the day. However, to study and pinpoint abnormalities in large quantities of data collected over several hours is strenuous and time consuming. Hence, heart rate variation measurement (instantaneous heart rate against time) has become a popular, non-invasive tool for assessing the autonomic nervous system. Computer-based analytical tools for the in-depth study and classification of data over day-long intervals can be very useful in diagnostics. The paper deals with the classification of cardiac rhythms using an artificial neural network and fuzzy relationships. The results indicate a high level of efficacy of the tools used, with an accuracy level of 80-85%.

Mind and consciousness in yoga - Vedanta: A comparative analysis with western psychological concepts.

Study of mind and consciousness through established scientific methods is often difficult due to the observed-observer dichotomy. Cartesian approach of dualism considering the mind and matter as two diverse and unconnected entities has been questioned by oriental schools of Yoga and Vedanta as well as the recent quantum theories of modern physics. Freudian and Neo-freudian schools based on the Cartesian model have been criticized by the humanistic schools which come much closer to the vedantic approach of unitariness. A comparative analysis of the two approaches is discussed.