Development and validation of tools to screen occupational mental health and workplace factors influencing it: for the Indian workforce.

An imbalance in the key organizational psychology constructs viz. "Workload", "Reward", "Community", "Control", "Values" and "Fairness" are potential factors leading to negative occupational mental health, i.e. burnout. Burnout, a psychological syndrome is the combination of emotional exhaustion, sense of reduced compassion and accomplishment. To note, the concept of occupational mental health in a nation with second largest workforce is nascent. Further, the utility of existing western tools in Indian subcontinent is limited by culturally inappropriateness, patented, less comprehensible and other factors. Present study attempted to develop tools to screen occupational mental health and workplace areas. Conventional steps involved in psychological tool development, viz. construct identification, drafting of pertinent questions, content validation, field testing of questions and others were adopted. After series of steps, tools for screening occupational mental health and key constructs influencing mental health at workplace (workplace assessment) were developed. The screening tools exhibited adequate test-retest reliability, internal consistency/reliability (cronbach's α>0.73) and correlation (correlation coefficient >0.6) with the general mental health in larger evaluation of 153 consenting workers. The proposed simple and easy to administer tool requires development of normative scores thereby aiding early diagnosis and management of those requiring intervention.

Resting state functional connectivity abnormalities and delayed recall performance in patients with amnestic mild cognitive impairment.

Amnestic Mild Cognitive Impairment (aMCI) represents the transition between healthy aging and Alzheimer's dementia (AD) wherein gradual impairment of cognitive abilities, especially memory sets in. Impairment in episodic memory, especially delayed recall, is a hallmark of AD and therefore, patients with aMCI with more severe impairment in episodic memory are considered to be at greater risk of imminent conversion to AD. Brain structural and functional abnormalities were examined by comparing gray matter volumes, white matter micro-structural integrity and resting state functional connectivity (rsFC), between patients with aMCI (n = 46) having lower vs. higher episodic memory delayed recall (EM-DR) performance scores, correcting the influences of age, sex, number of years of formal education and total brain volumes using voxel-based morphometry, whole-brain tract based spatial statistics and dual regression analysis respectively. 'Low' performers (n = 27) when compared to 'high' performers (n = 19) showed significantly increased rsFC in the dorsal attention network (DAN) and central executive network (CEN) in the absence of demonstrable gray matter volumetric or white matter micro-structural integrity differences at family-wise error (FWE) corrected (p < 0.05) significance threshold. Follow-up data available for 38 (low performers = 22; high performers = 16) of the above 46 subjects (82.60% follow-up rate) over a median follow-up period of 24.5 months revealed that 7 subjects (18.42%) had converted to dementia. These converted subjects included 5 of the 22 low performers (22.72%) and 2 of the 16 high performers (12.5%) within the follow-up sample (n = 38). The results of the study indicate that imminent conversion of aMCI to dementia is higher in low performers in comparison to high performers, which may be characterized by increased rsFC in task positive networks, viz., DAN and CEN, as opposed to gray or white matter structural changes. This finding, therefore, might be considered as a prognostic indicator of progression from aMCI to dementia.

Differentiation of Early Alzheimer's Disease, Mild Cognitive Impairment, and Cognitively Healthy Elderly Samples Using Multimodal Neuroimaging Indices.

Brain resting-state functional connectivity (rsFC), white matter (WM) integrity, and cortical morphometry, as well as neuropsychological performance, have seldom been studied together to differentiate Alzheimer's disease (AD), mild cognitive impairment (MCI), and elderly cognitively healthy comparison (eCHC) samples in the context of the same study. We examined brain rsFC in samples of patients with mild AD (n = 50) and MCI (n = 49) in comparison with eCHC samples (n = 48) and then explored whether rsFC abnormalities can be linked to underlying gray matter (GM) volumetric and/or WM microstructural abnormalities. The mild AD sample showed significantly increased rsFC in the executive control network (ECN) and dorsal attention network (DAN) compared with the eCHC sample, and increased rsFC in ECN compared with MCI. Brain regions corresponding to both these resting-state networks (RSNs) showed significant reduction in fractional anisotropy in mild AD in comparison with eCHC. Significant GM volumetric reductions were observed in brain regions corresponding to both RSNs in the mild AD sample compared with MCI as well as eCHC samples. The association of default mode network-DAN anticorrelation with cognitive performances differentiated mild AD and MCI from eCHC sample. These findings highlight the association between brain structural and functional abnormalities as well as cognitive impairment that enables differentiation between early AD, MCI, and eCHC samples.

Indian older adults and the digit span A preliminary report.

The digit span test is widely used to assess attention and working memory. It is a portable, relatively culture-free and frequently used test. However, the cultural validity of this test, particularly in the Indian older population, is not well established. OBJECTIVE: This study explores the usefulness of the digit span test for Indian older adults with different levels of education. METHODS: Two hundred and fifty-eight community-dwelling healthy normal older adults formed the sample of this study. All study participants were screened using a semi-structured interview schedule, the modified MINI Screen, the Indian version of the Mini-Mental State Examination, a measure of activities of daily living and the digit span test administered verbally. RESULTS: The results indicated that participants with higher educational level performed significantly better than low-educated participants on the digit span test. Participants with low education often struggled with the digit span test and resorted to guessing the digits. CONCLUSION: Our study clearly demonstrates that the digit span test can be useful for educated participants. However, its usefulness and ecological validity is questionable for those with low education and low literacy, warranting future research.

O teste de span de dígitos é amplamente utilizado para avaliar a atenção e a memória de trabalho. É um teste portátil, relativamente livre de cultura e frequentemente usado. No entanto, a validade cultural deste teste, particularmente na população idosa indiana, não está bem estabelecida. OBJETIVO: Este estudo explora a utilidade do teste de amplitude de dígitos para idosos indianos com diferentes níveis de educação. MÉTODOS: Duzentos e cinquenta e oito idosos saudáveis ​​normais residentes na comunidade formaram a amostra deste estudo. Todos os participantes da pesquisa foram selecionados usando uma entrevista semiestruturado, MINI Screen modificado, versão indiana do Mini Mental State Examination, uma medida de atividade da vida diária e teste do span de dígitos administrados verbalmente. RESULTADOS: Os resultados indicaram que os participantes com alto nível de escolaridade tiveram desempenho significativamente melhor do que os participantes com baixo nível de escolaridade no teste de amplitude de dígitos. Participantes com baixa escolaridade muitas vezes enfrentaram difficuldades com o teste de amplitude de dígitos e recorreram a adivinhar os dígitos. CONCLUSÃO: Nosso estudo demonstra claramente que o teste de amplitude de dígitos pode ser útil para participantes instruídos. No entanto, sua utilidade e validade ecológica são questionáveis ​​para aqueles com baixa escolaridade e letramento, requerendo pesquisas futuras.

Indian older adults and the digit span: a preliminary report / Idosos indianos e extensão de dígitos: um relatório preliminar

ABSTRACT: The digit span test is widely used to assess attention and working memory. It is a portable, relatively culture-free and frequently used test. However, the cultural validity of this test, particularly in the Indian older population, is not well established. Objective: This study explores the usefulness of the digit span test for Indian older adults with different levels of education. Methods: Two hundred and fifty-eight community-dwelling healthy normal older adults formed the sample of this study. All study participants were screened using a semi-structured interview schedule, the modified MINI Screen, the Indian version of the Mini-Mental State Examination, a measure of activities of daily living and the digit span test administered verbally. Results: The results indicated that participants with higher educational level performed significantly better than low-educated participants on the digit span test. Participants with low education often struggled with the digit span test and resorted to guessing the digits. Conclusion: Our study clearly demonstrates that the digit span test can be useful for educated participants. However, its usefulness and ecological validity is questionable for those with low education and low literacy, warranting future research.

RESUMO: O teste de span de dígitos é amplamente utilizado para avaliar a atenção e a memória de trabalho. É um teste portátil, relativamente livre de cultura e frequentemente usado. No entanto, a validade cultural deste teste, particularmente na população idosa indiana, não está bem estabelecida. Objetivo: Este estudo explora a utilidade do teste de amplitude de dígitos para idosos indianos com diferentes níveis de educação. Métodos: Duzentos e cinquenta e oito idosos saudáveis ​​normais residentes na comunidade formaram a amostra deste estudo. Todos os participantes da pesquisa foram selecionados usando uma entrevista semiestruturado, MINI Screen modificado, versão indiana do Mini Mental State Examination, uma medida de atividade da vida diária e teste do span de dígitos administrados verbalmente. Resultados: Os resultados indicaram que os participantes com alto nível de escolaridade tiveram desempenho significativamente melhor do que os participantes com baixo nível de escolaridade no teste de amplitude de dígitos. Participantes com baixa escolaridade muitas vezes enfrentaram difficuldades com o teste de amplitude de dígitos e recorreram a adivinhar os dígitos. Conclusão: Nosso estudo demonstra claramente que o teste de amplitude de dígitos pode ser útil para participantes instruídos. No entanto, sua utilidade e validade ecológica são questionáveis ​​para aqueles com baixa escolaridade e letramento, requerendo pesquisas futuras.

First 2 Years of Experience of "Residential Care" at "Sakalawara Rehabilitation Services," National Institute of Mental Health and Neurosciences, Bengaluru, India.

INTRODUCTION: There is an unmet need for continuity-of-care is well known for those with severe mental disorders (SMDs) after acute care at hospitals in India. The "Sakalawara Rehabilitation Services (SRS)" functioned from March 2014 at "Sakalawara Community Mental Health Centre" (SCMHC) of "National Institute of Mental Health and Neurosciences," Bengaluru, India in the concepts of residential care (half-way-home) with the aim to develop a replicable model. AIM: To review the inpatient records after the initial 2 years of experience in residential care at SCMHC. METHODOLOGY: Retrospective file review of inpatients at SCMHC from March 2014 to March 2016 in a semi-structured proforma designed for the study. Ethical committee of NIMHANS Bengaluru has approved the study. RESULTS: The total number of inpatients during this period was 85. It was found that Schizophrenia spectrum disorders were the most common diagnosis among these patients. The activity of daily living and psycho-education were the most common individual interventions. The majority of families underwent structured family psycho-educational interventions. This review also demonstrated the feasibility of tele-aftercare in continuity of care after discharge of patients. CONCLUSION: SRS kind of residential set-up is feasible and demonstrated effectiveness in maintaining continuity of care of SMDs. There is a need for better structured and customized interventions. There is further a scope for tele (video) aftercare for those with SMDs.

Clinical and neuropsychological profile of persons with mild cognitive impairment, a hospital based study from a lower and middle income country.

Mild Cognitive impairment (MCI) is an important pre-dementia stage to be identified towards prevention. We screened a large number of older adults seeking help at hospital and community towards a diagnosis of MCI and this study describe their clinical and neuropsychological profile. Older adults aged 60 years & above seeking help at NIMHANS outpatient & community services were screened for early cognitive deficits. Persons were diagnosed to have MCI according to Petersen's criteria, after detailed clinical and neuropsychological assessments. Age, gender and education matched healthy controls were recruited for comparison. A total of 7469 older adults were screened during the study period (July 2012-December 2014). Less than 1% (n=56) were diagnosed with MCI. Majority were males, from urban background with an average of 13 years of education. They presented mainly with memory disturbances, more than 75% (n=43) were found to have amnestic type of MCI (aMCI). Of the aMCI subjects, majority (80%) had deficits in more than one cognitive domain. They performed significantly worse (p<0.001) on tests of episodic memory, logical memory, attention and executive functions. Neuropsychiatric symptoms were prevalent in 55% of MCI group and influenced their cognitive scores. The findings suggest that persons with MCI perform worse not only on memory tasks but also on some of the attention and executive functions tasks. As observed in earlier studies, amnestic multiple-domain MCI was the most common type of MCI in this study population. Indigenous assessment tools were of significant value in distinguishing MCI from normal ageing.

Psychological recovery and its correlates in adults seeking outpatient psychiatric services: An exploratory study from an Indian tertiary care setting.

The study was designed to explore psychological recovery and its correlates in adults receiving outpatient mental health services for psychiatric disorders. It specifically aimed at examining the association of psychological recovery with symptomatic and functional recovery and with selected illness and treatment variables. The relationship of psychological recovery with perceived social support was also the focus of inquiry. The study utilized a cross sectional survey design with a sample of 90 participants diagnosed with severe and common mental illness who had been seeking outpatient psychiatric follow up services. The data was collected with the help of both clinician rated and self-rated measures. The study findings suggested that symptomatic, functional and psychological recovery are significantly correlated but not completely overlapping constructs. Nearly 40% of the sampled participants were at the lower stages of psychological recovery, despite the fact that a majority of them were rated by clinicians as having mild or lower severity of symptoms. With respect to socio-demographic variables, a significant association was found between higher levels of education and psychological recovery. The participants with common mental illness were significantly lower on self-reported improvement and higher on moratorium subscale of psychological recovery (as compared to those with severe mental illness), indicating their struggle in dealing with a sense of loss and despair. Findings also suggested that higher levels of overall perceived social support is likely to facilitate psychological recovery.

Pathways to care among persons with dementia: Study from a tertiary care center.

The prevalence of dementia is increasing rapidly, specifically in low and middle income countries (LAMIC) due to demographic aging. Help seeking is delayed and usually sought at an advanced stage of illness and many are yet to receive a formal diagnosis. We interviewed 35 caregivers of persons with Dementia (as per ICD-10) using a semi-structured questionnaire, the Short Explanatory Model Interview (SEMI). We explored the pathways taken by caregivers of people with dementia en route to a tertiary care centre and the interactions they had with different health care providers. Qualitative data analysis was done using ATLAS.ti. We identified three major pathways: I) The Neuropsychiatric pathway II) The General Practitioner pathway and III) The Non-cohesive pathway. In general, the caregivers were poorly informed about the illness details such as diagnosis, course and outcome. Neurologists communicated the diagnosis of 'Dementia' more frequently. When information was made available, the caregivers were satisfied with proper information about illness and with at least, partial improvement of symptoms. There is a need for increasing the awareness of dementia in community at large. Health services and systems that address this important public health problem need strengthening. Sensitization and training of primary care physician and staff to identify dementia at an early stage are the need of the hour.

Effect of CLU and PICALM polymorphisms on AD risk: A study from south India.

OBJECTIVES: To study the association of apolipoprotein E (APOE), Clusterin (CLU) and phosphatidylinositol binding clathrin assembly protein (PICALM) polymorphisms in Alzheimer's disease (AD) subjects compared to cognitively normal control subjects in an Indian population. METHODS: The study subjects included persons with AD (N=243) and age group matched healthy controls (N=164). All the AD subjects were evaluated using a standard protocol. DNA was isolated from whole blood. APOE (rs7412, rs429358), CLU (rs11136000) and PICALM (rs3851179) were genotyped. General linear model was used to test the association between the individual risk genotypes and AD. RESULTS: The presence of APOE ε4 was associated with AD after adjusting for age and gender (p<0.0001). There was no association observed with AD at both rs11136000 CLU (p=0.25) and rs3851179 PICALM (p=0.54). CONCLUSION: Our results confirmed a significant association of APOE ε4 carrier status with AD. No association was observed for CLU and PICALM with AD. This might be due to a different genetic background. There are no previous reports of these polymorphisms in an Indian cohort. Future Indian AD studies should investigate additional SNPs in a larger sample size in these genes.

Quantitative Balance and Gait Measurement in Patients with Frontotemporal Dementia and Alzheimer Diseases: A Pilot Study.

INTRODUCTION: Alzhiemers disease and Frontotemporal dementia are common neurodegenerative dementias with a wide prevalence. Falls are a common cause of morbidity in these patients. Identifying subclinical involvement of these parameters might serve as a tool in differential analysis of these distinct parameters involved in these conditions and also help in planning preventive strategies to prevent falls. PATIENTS AND METHODS: Eight patients in age and gender matched patients in each group were compared with normal controls. Standardizes methods of gait and balance aseesment were done in all persons. RESULTS: Results revealed subclinical involvement of gait and balancesin all groups specially during divided attention. The parameters were significantly more affected in patients. Patients with AD and FTD had involement of over all ambulation index balance more affected in AD patients FTD patients showed step cycle, stride length abnormalities. DISCUSSION: There is balance and gait involvement in normal ageing as well as patients with AD and FTD. The pattern of involvement in AD correlates with WHERE pathway involvement and FTD with frontal subcortical circuits involvement. CONCLUSION: Identification the differential patterns of involvement in subclinical stage might help to differentiate normal ageing and the different types of cortical dementias. This could serve as an additional biomarker and also assist in initiating appropriate training methods to prevent future falls.

Long Loop Reflex 2 in Patients with Cortical Dementias: A Pilot Study.

INTRODUCTION: Dementia is a major public health problem and it appears to be a global epidemic. The prevalence is doubling every 5 years and it is expected that 70% of persons above 60 years will live in developing countries by 2020 and 15% of them are likely to suffer from dementia. Disease modifying treatments work only if initiated very early; however, diagnostic tools are not always able to clearly differentiate the different types in very early stage. Therefore, inexpensive and easily available biomarkers are needed to know if collectively they will improve the sensitivity of specific diagnosis. Therefore, in this pilot study, we have tried to analyze if long loop reflex (LLR2) is differentially affected in these two conditions early in the course of Alzheimer's dementia (AD) and frontotemporal dementia (FTD) based on hypothesis taking into account the anatomical substrates involved. PATIENTS AND METHODS: Mild cases of clinically probable AD and FTD after appropriate inclusion criteria were subjected for LLR testing in the upper limb at median nerve. The presence or absence of LLR was assessed and also the latency, amplitude, and duration assessed. RESULTS AND CONCLUSION: LLR 2 is differentially affected in both these conditions. Absence of LLR2 was consistently seen in FTD which can be explained by early break down of frontal subcortical circuits in this condition as against AD. This is likely to serve as a very cheap and very early biomarker to differentiate the two common types of cortical dementias.

Clinical characteristics of patients with non-affective, non-organic, late onset psychosis.

OBJECTIVE: Schizophrenia and related psychotic disorders are predominantly studied in young population. However some individuals do develop psychotic disorder for the first time during their old age. The aim of this study is to look at the clinical characteristics of non-affective, non-organic, late onset psychosis. PARTICIPANTS AND METHODS: Retrospective chart review study, medical records of all patients registered between 1st of January 2006 and 31st May 2011 at geriatric clinic in NIMHANS, Bangalore was screened, 83 files with a diagnosis of late onset psychosis and meeting the study criteria were systematically analyzed. RESULTS: The mean age at onset of illness was 67±10years; 98.8% were married, females formed 67.5% of the sample, commonest phenomenon was delusions followed by hallucinations, 80.5% of the subjects had delusion of persecution, 38.5% had referential delusion, 51.8% had accusative and derogatory auditory hallucinations, negative symptoms was seen only in 2.4% of subjects, none had formal thought disorder. 3.6% had co-morbid Axis II diagnosis. CONCLUSION: Despite its rarity non affective, non organic, late onset psychosis forms a distinct group with unique manifestation. Further systematic research is needed for better understanding of this condition.

Resting-State Functional Connectivity Changes Associated with Visuospatial Cognitive Deficits in Patients with Mild Alzheimer Disease.

BACKGROUND/AIMS: Alzheimer disease (AD) is a neurodegenerative disorder characterized by progressive disconnection of various brain networks leading to neuropsychological impairment. Pathology in the visual association areas has been documented in presymptomatic AD and therefore we aimed at examining the relationship between brain connectivity and visuospatial (VS) cognitive deficits in early AD. METHODS: Tests for VS working memory, episodic memory and construction were used to classify patients with AD (n = 48) as having severe VS deficits (n = 12, female = 4) or mild deficits (n = 11, female = 4). Resting-state functional magnetic resonance imaging and structural images were acquired as per the standard protocols. Between-group differences in resting-state functional connectivity (rsFC) were examined by dual regression analysis correcting for age, gender, and total brain volume. RESULTS: Patients with AD having severe VS deficits exhibited significantly reduced rsFC in bilateral lingual gyri of the visual network compared to patients with mild VS deficits. CONCLUSION: Reduced rsFC in the visual network in patients with more severe VS deficits may be a functional neuroimaging biomarker reflecting hypoconnectivity of the brain with progressive VS deficits during early AD.

A Multimodal Structural and Functional Neuroimaging Study of Amnestic Mild Cognitive Impairment.

Examination of brain structural and functional abnormalities in amnestic mild cognitive impairment (aMCI) has the potential to enhance our understanding of the initial pathophysiological changes in dementia. We examined gray matter volumes and white matter microstructural integrity, as well as resting state functional connectivity (rsFC) in patients with aMCI (N = 48) in comparison to elderly cognitively healthy comparison subjects (N = 48). Brain volumetric comparisons were carried out using voxel-based morphometric analysis of T1-weighted images using the FMRIB Software Library. White matter microstructural integrity was examined using whole-brain tract-based spatial statistics analysis of fractional anisotropy maps generated from diffusion tensor imaging data. Finally, rsFC differences between the samples were examined by Multivariate Exploratory Linear Optimised Decomposition into Independent Components of the resting state functional magnetic resonance imaging time series, followed by between-group comparisons of selected networks using dual regression analysis. Patients with aMCI showed significant gray matter volumetric reductions in bilateral parahippocampal gyri as well as multiple other brain regions including frontal, temporal, and parietal cortices. Additionally, reduced rsFC in the anterior subdivision of the default mode network (DMN) and increased rsFC in the executive network were noted in the absence of demonstrable impairment of white matter microstructural integrity. We conclude that the demonstrable neuroimaging findings in aMCI include significant gray matter volumetric reductions in the fronto-temporo-parietal structures as well as resting state functional connectivity disturbances in DMN and executive network. These findings differentiate aMCI from healthy aging and could constitute the earliest demonstrable neuroimaging findings of incipient dementia.

Mindfulness-based cognitive therapy in patients with late-life depression: A case series.

Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression.