Psychometric properties and factor structure of the suicidal narrative inventory in major depression: A multicentric evaluation.

BACKGROUND: The Suicidal Narrative Inventory (SNI) is a 38-item self-report measure developed to assess elements of the suicidal narrative, a subacute, predominantly cognitive, presuicidal construct. Our objectives were to assess the factor structure, validity, and reliability of the SNI-38 among adults with major depressive disorder (MDD). METHODS: Using a cross-sectional design, we administered the Hindi version of the SNI along with other self-report measures to adults with MDD, recruited from 24 tertiary care hospitals across India. Confirmatory factor analysis (CFA) was performed to assess the factor structure of SNI-38. Reliability (internal consistency) was assessed using Cronbach's alpha (α). Convergent, discriminant, and criterion validity of the SNI-38 were tested by comparing it against other appropriate measures. RESULTS: We collected usable responses from 654 Hindi-speaking participants (Mean age = 36.9 ± 11.9 years, 50.2% female). The eight-factor solution of the SNI showed good model fit indices (χ2[637] = 3345.58, p <.001, CFI =.98, and RMSEA =.08). Internal consistencies for the SNI subscale scores were good to excellent, α ranging from .73 to.92. While most subscales significantly converged with other measures, associations were comparatively weaker and inconsistent for the 'thwarted belongingness' and 'goal reengagement' subscales. CONCLUSION: Consistent with prior data, our study confirmed an eight-factor solution and demonstrated adequate psychometric properties for the Hindi version of the SNI-38 in our sample. These findings provide empirical support for the use of SNI to assess the suicidal narrative among Indian adults with MDD.

Management of Psychiatric Disorders in Patients with Endocrine Disorders.

The neuropsychiatric symptoms and disorders among endocrine disorders are discussed in the context of current global and local epidemiological data. Neuropsychiatric symptoms, clinical differentials in hypothyroidism, hyperthyroidism, and parathyroid disorders, and relevant management protocols are described. HPT axis and its interaction with psychotropic usage are mentioned. Stress diathesis, depression, anxiety disorders, and severe mental illnesses and their respective association with diabetes, the relevant mechanisms, and management protocols are stated. The metabolic syndrome, its definition, and its relationship to psychotropic usage are laid out. Moreso, best clinical practices for scenarios such as hyperprolactinemia and psychiatric illnesses, and steroid-induced psychosis are mentioned.

Absence of undergraduate medical students from psychiatric training: A study from central India.

BACKGROUND: Psychiatric problem is as common as among the 25% of the general population and 15% patients attending specialty clinic. Majority of the cases are dealt by primary care physician at the first contact, but there is only 2 weeks of clinical posting and 20 h of theory classes during MBBS course. Earlier studies have reported low attendance during the posting and theory classes. There are few studies on this aspect. On this background, the present study was planned. METHODOLOGY: One hundred 8th semester students of MBBS from two medical colleges (Group A government aided college and Group B from Private college under autonomous university) from the same locality of Central Maharashtra were selected for the study after due approval by the Institutional Ethical Committee. Questionnaire was prepared by the psychiatric faculty of both institutes and administered to the individual students. The data were analyzed using suitable statistical methods (Chi-square test and t-test). RESULTS: Only 27% of the students in Group A attended 25%-30% of clinical posting, whereas none of them attended a single theory class. While in Group B, 1/3rd of students attended 30%-40% of clinical posting and 20%-25% of theory class. No separate examination in the subject (88%-94%) and adjustment of attendance in the other major subjects (64-86%) were cited as main reasons for nonattendance among the majority of the students in both the groups. CONCLUSION: Strict adherence to the attendance by the institutional authority, increase in the training hours and separate examination in the subject at undergraduate level may help in improving the attendance and change in attitude of the students toward psychiatry.

Changes in sleep pattern and sleep quality during COVID-19 lockdown.

INTRODUCTION: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted "lockdowns" which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. MATERIALS AND METHODS: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. RESULTS: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. CONCLUSIONS: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.

Factors influencing suicidal attempt among the agrarian community of central Maharashtra.

INTRODUCTION: Attempted suicides occur 8-20 times more frequently than completed suicides. Attempted suicides are just the tip of the iceberg of the completed suicides, now a universal phenomenon. Several factors such as financial constraints, altercation among family members, and easy availability of pesticides have been attributed as the common factors for attempted suicide among the rural population. MATERIALS AND METHODS: On this background, we evaluated all the cases of attempted suicide admitted to our rural medical college during a period of 1 year. Details of sociodemographic profile, mode of attempt, and reason for the attempt were evaluated. All the cases were administered Beck's Depression Inventory. Factors influencing suicidal attempts among farmers and nonfarmers were analyzed using suitable statistical methods. RESULTS: Out of a total of 117 cases of attempted suicide, only 21% of the cases were farmers. Majority of them were males and were married. The main mode of attempt was poisoning. The common psychiatric diagnosis was adjustment disorder followed by depressive disorder. CONCLUSION: Although the study was conducted in a rural setup from an agrarian background, the majority of the cases were of nonfarmer. The most common mode of suicidal attempt among farmers as well as nonfarmers was pesticide ingestion owing to its easy availability among the agrarian population. Although the most common reason for attempt among the nonfarmer population was interpersonal problems, indebtedness still remains the most common reason for farmers. Attention of policymakers is drawn toward two important aspects: policy on the sale of usual pesticides and policy for the farmers to overcome loss in farming.

Neuropsychiatric Manifestation of Hashimoto's Encephalopathy in an Adolescent and Treatment.

Hashimoto's encephalopathy is usually underdiagnosed and untreated because of complex neuropsychiatric manifestation. We report a case of an adolescent female with Hashimoto's encephalopathy who responded well to a combination of aspirin and levothyroxine. A 16-year-old girl presented at psychiatric emergency services with a depressive episode, menstrual irregularities, and a 5-month past history of thyroid swelling. On clinical examination, she was in a euthyroid state with insignificant neurological history. However, her previous investigation revealed a hypothyroid state. Her magnetic resonance imaging findings demonstrated infarcts in the bilateral gangliocapsular region and left frontal periventricular deep white matter lesion. Ultrasonography of the thyroid and fine needle aspiration cytology confirmed lymphocytic thyroiditis. Anti-thyroid peroxidase (289 IU/ml) antibody titer was elevated (289 IU/mL). Her depressive symptoms responded well to antidepressants, mood stabilizers, nonsteroidal anti-inflammatory drugs, and levothyroxine. She remained in the euthyroid state and then in the euthymic state for 3 years. Hashimoto's encephalopathy is steroid-responsive encephalopathy. Most researchers have observed a dramatic response to steroids with or without levothyroxine. A clinician may consider aspirin as an alternative to a steroid in long-term management to avoid steroid-related side effects and contraindications.

Sociodemographic profile of suicide attempters among the rural agrarian community of central India.

BACKGROUND: Suicides, attempted suicides and different form of suicidal behaviors are on the rise in most part of the world. It is generally assumed that official suicidal rate are underestimated from the true rate by 20-100 % due to prevailing socio-cultural issues, religious attitude, stigma attached, and legal process involved. Attempted suicides occur 8-20 times more frequently than complete suicide. Statistics on attempted suicide or deliberate self harm are not usually available officially. MATERIALS AND METHODS: All the cases of attempted suicide who were admitted and referred for psychiatric evaluation and management to a rural medical college of central India during a period of one Year (April 13-March-14), following initial recovery they were evaluated on a semi-structured performa on socio demographic profile, mode of attempt and reason for attempt. Data collected was analyzed using suitable statistical methods. RESULTS: Total 68 cases were evaluated during the study period. 43% of the cases were involved in farming. Among 85% of the study population pesticide consumption was the common mode of attempt, which is easily available among the agrarian community of rural India. Interpersonal conflict in the family due to indebtedness, financial loss due to crop failure was the commonest reason for attempt. CONCLUSION: Though there is reduced reporting in the incidents of suicide cases in media from this region, still quite a number of people attempt suicide due to financial constraint from crop failure, ongoing indebtedness, and poor socioeconomic condition culminating into poor mental health among the rural agrarian community of central Maharashtra.