Symptoms and psychosocial effects following hospitalization for Covid-19: A sequential, mixed-methods study from northern India.

Background It is reported that patients who have recovered from Covid-19 continue to experience various symptoms and adverse outcomes. However, this aspect has not been studied well. We aimed to evaluate these variables and the perceived impact of Covid-19 among patients discharged from a Covid hospital in northern India. Methods We conducted this study among patients discharged from a Covid-19 hospital in northern India in June 2020. As per the official policy at that time, patients detected to have Covid-19 (symptomatically or via contact tracing) were mandatorily admitted. A sequential, mixed-methods design was followed. Patients discharged from the hospital were contacted telephonically, and the cross-sectional prevalence of symptoms, the prevalence of depression and anxiety and the social consequences of admission were assessed. A subgroup of patients was interviewed for qualitative assessment of their experience. Results A total of 274 patients provided consent and were assessed, of which 8 patients underwent detailed interviews. The prevalence of somatic symptoms was 3.4%; 36.2% of the patients had depressive and 12% of the patients had anxiety symptoms. A majority of patients experienced adverse social and economic consequences of hospitalization for Covid-19. These themes were reinforced by a qualitative analysis of in-depth interviews. Conclusions Our study population experienced a high prevalence of adverse psychosocial consequences of Covid-19. These included depression and anxiety symptoms, stigma and economic and occupational consequences. These deserve more recognition and study.

Psychological morbidity in pemphigus patients in clinical remission and its relation with clinico-demographic parameters.

BACKGROUND AND OBJECTIVES: Significant psychological morbidity exists in patients with active pemphigus. Pemphigus being a chronic disease, psychological morbidity may exist in pemphigus patients in remission as well. The objectives of the study were to assess the psychological morbidity in pemphigus patients in clinical remission and to correlate it with clinico-demographic parameters. PATIENTS AND METHODS: Pemphigus patients in clinical remission were consecutively included and were asked to respond to the Hindi/English version of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) and panic disorder module of PHQ. RESULTS: Of 107 patients recruited, 41 (38.3 %, 95 % CI: 29.1-48.2 %) patients were found to have either depression (33 [30.8 %, 95 % CI: 22.2-40.5 %]) or anxiety (38 [35.5 %, 95 % CI: 26.5-45.4 %] syndrome based on cut-offs of PHQ-9 score and GAD-7 score, respectively. Number of patients with mild, moderate and moderately severe/severe depression syndrome were 26 (24.3 %, 95 % CI: 17.2-33.2 %), 7 (6.5 %, 95 % CI: 0.3-12.9 %) and 0 respectively and patients with mild, moderate, severe anxiety syndrome were 29 (27.1 %, 95 % CI: 19.6-36.2 %), 9 (8.4 %, 95 % CI: 4.5-15.2 %) and 0 respectively. Patients with anxiety or depression syndrome had significantly higher clinical disease activity in the past, number of days spent in dermatology inpatient and significantly shorter clinical remission at the time of assessment as compared to those without these symptoms. CONCLUSIONS: Significant burden of mild/moderate depression or anxiety syndrome associated with past severity of disease and shorter duration of clinical remission was found.

Proactive case finding for severe mental illness in a rural area in the Indian Punjab: findings and lessons.

People with severe mental illnesses may experience barriers in accessing community mental health services. We used the key informant method to detect people with untreated severe mental illness in seven villages in the Indian state of Punjab. The key informant was a local community leader. We were able to contact 11 patients who were identified as suffering from severe mental illness by the key informants. On assessment, eight of them had intellectual disability and three had psychotic and affective illness. We discuss the barriers and opportunities for providing mental health services in the community.

The Experience and Reactions towards Stage 1 COVID-19 among Junior Doctors in India.

BACKGROUND: COVID-19 pandemic is the first modern pandemic and has occurred in an era of social media ubiquity. Despite being in stage 1 of the pandemic, and low numbers of patients, various emotional and behavioral changes were observed in junior doctors. This study was designed to assess the experience and reactions of junior doctors in a tertiary teaching hospital in North India and Tamil Nadu in the immediate aftermath of the nation-wide lockdown. SUBJECTS AND METHODS: This was an observational cross- sectional study of junior doctors working in tertiary care hospitals in Chandigarh and Tamil Nadu. It was conducted from 28th March to 5th April 2020. Ethical clearance obtained and anonymity was maintained. We used a 17-item self-designed questionnaire circulated online. RESULTS: Mean age was 28.64 years (n=362). Though mostly well informed, only 8% restricted themselves to obtaining information from a single source. Around 46% were feeling anxious and many more (73.20%) perceived the same emotion in their peers and even more of them (85.10%) in their family members. Most of them (90.1%) endorsed more than change in behavior, mainly to avoid potential risk (52%) and females tend to self-quarantine themselves more than males. CONCLUSIONS: Knowledge does not play as important a role in the way people behave in an outbreak. Many other covert factors may possible be involved. Strategies leading to reduction in uncertainty, interventions for reassurance in the workplace and better role models would be of help in this outbreak.

Physicians' Reactions to COVID-19: The Results of a Preliminary International Internet Survey.

OBJECTIVES: Physicians across the world have been disproportionately affected by the COVID-19 pandemic. This study was designed and conducted to assess the emotional and behavioural reactions of physicians to the initial phase of the COVID-19 pandemic. SUBJECTS AND METHODS: An online survey questionnaire using the google forms platform was constructed by the authors. The items in the questionnaire were based on clinical experience, relevant literature review and discussion with peers. A list of issues that were deemed as essential components of the experience of the pandemic relevant to physicians was arrived at. Thereafter these issues were operationalized into question form and hosted on the google forms platform. The link to this questionnaire was circulated by the authors among their peer groups in the month of April 2020. RESULTS: We received 295 responses and 3 were unusable. Most of the responses were from India, the United States of America, Australia, Canada and the United Kingdom. About 60% of the respondents identified themselves as frontline and had a decade of clinical experience. Most respondents reported being anxious due to the pandemic and also observed the same in their peers and families. A majority also observed changes in behaviour in self and others and advanced a variety of reasons and concerns. A sense of duty was the most commonly employed coping mechanism. CONCLUSION: Physicians are not immune from information and misinformation, or cues in the environment. Behavioural choices are not always predicted by knowledge but by a combination of knowledge, emotional state, personality and environment. Healthcare settings need to be ready for emergencies and should focus on reducing uncertainty in physicians. These factors may also be gainfully used in the mental health promotion of physicians in COVID-19 care roles.

A Study of Hypertension and Related Biophysical and Health-related Lifestyle Behaviors in Patients Suffering from Schizophrenia.

Background: Schizophrenia is a life-shortening disease. The standardized mortality ratio has been higher than that of the general population, and it has doubled what it was 3-4 decades ago. This rise is mostly attributed to the increased cardiovascular risk associated with high second-generation antipsychotic (SGA) use. Evidence from the first-generation antipsychotic (FGA) era shows a lower prevalence of hypertension (HTN) but data regarding SGAs is scarce. Purpose: The purpose of the study was to assess the prevalence of HTN and related factors using standardized methodology in patients with schizophrenia on treatment with SGAs. Methods: A cross-sectional study through convenient sampling was done. Blood pressure, anthropometry, physical activity, and health-related lifestyle factors were assessed using the standard World Health Organization (WHO) methodology of cardiovascular survey methods and the Global Physical Activity Questionnaire (GPAQ) version 2. The prevalence of HTN, obesity, inadequate physical activity, and other demographic and clinical correlates like antipsychotic use, duration of illness, and family history of non-communicable diseases (NCDs) were studied. Results: The prevalence of HTN is 20.50%, and it increases with age. SGAs with the use of a single agent are the most common. In total, 45.50% of persons with schizophrenia have a positive family history of a NCD; 22.00% and 07.50% are current tobacco and alcohol users, respectively; and 70% have abdominal obesity, and 54% have generalized obesity. Waist circumference, obesity, and family history of NCDs are significant correlates of HTN. A family history of NCDs is the most significant predictor. Conclusion: The prevalence of HTN is lower than that of the general population despite the high prevalence of SGA use, obesity, and inadequate physical activity.

Depression, Anxiety, and Quality of Life in Patients Treated with Single Infusion Tocilizumab for COVID-19: A Follow-up, Controlled Study.

Background: The inflammatory state that characterizes COVID-19 may contribute to depression, anxiety, other morbidities, and mortality. Interleukin-6 blocker tocilizumab has been used as a treatment modality in COVID-19 as an anti-inflammatory agent. Tocilizumab has also been studied for its potential use in preventing depression in other patient groups, with mixed results. This study was designed to study subsequent depression, anxiety, and quality of life (QOL) in patients treated with tocilizumab plus standard care versus standard care alone, for moderate to severe COVID-19 pneumonia. Methods: Patients admitted with moderate to severe COVID pneumonia, treated with tocilizumab plus standard treatment, and discharged from the hospital were identified. Age- and gender-matched controls who had received standard treatment alone for COVID-19 pneumonia during the same time frame were identified. After obtaining consent, these patients were followed up and assessed at 3 and 6 months on measures of depression (PHQ-9), anxiety (GAD-7), and QOL (EQ-5D-5L). Results: 39 patients in the tocilizumab group and 41 in the control group were followed up at 3 and 6 months. Patients in both groups were comparable in sociodemographic and clinical parameters. The prevalence of clinically significant depression in the tocilizumab group at 3 and 6 months was 33.33% and 5.12%, respectively, whereas in control group it was 31.7% and 4.87%, respectively. Analysis of EQ-5D health profiles revealed that the maximum problems were reported in the dimension of mobility: 43.7% at 3 months and 35% at 6 months. Conclusions: Depressive and anxiety symptoms and impairment in QOL were reported more frequently and with greater severity in patients in the tocilizumab group at three months but not at six months. Psychological morbidity and impairment in QOL were modest and improved from 3 to 6 months.

Correlates of loneliness and dissatisfaction following SARS pandemic lockdown: Child and parent perspective.

Background Studying loneliness among children is important because it causes much social pain and is considered to be a risk factor for many mental and physical problems. Methods We did an online survey between July and September 2020 among students and their parents from a cluster of government and private schools chosen from north, south, east and west of Chandigarh. The survey consisted of child and parent versions of the Loneliness and Social Dissatisfaction Questionnaire, Parent-Child Relationship (PCR) Questionnaire and Conflict Behaviour Questionnaire SF. Parental distress was assessed using the Depression, Anxiety and Stress Scale-21. Results The majority of children and parent participants reported high loneliness and dissatisfaction among children. A significant positive association was found between children and parent reported loneliness and dissatisfaction, and between child reported PCR and parent perception of PCR. A child's appraisal of her loneliness had a significant negative association with depression among parents. Parent's perception of child loneliness and dissatisfaction was negatively associated with PCR and parental anxiety. High loner boys reported poor quality of relationship and more conflicts with their parents than girls. Children who share cordial relations with their parents had fewer conflicts and also scored low on loneliness. Conclusion These results suggest that the issue of loneliness and dissatisfaction among children has attained epidemic proportions in the Covid-19 era, and active interventions are needed to safeguard the mental health of children. Our study emphasizes the need to plan guidance strategies with a joint effort of schools and families to strengthen within family relations of children.

Quality of life in patients of corrosive esophageal stricture treated with endoscopic dilatation.

BACKGROUND AND AIM: Caustic ingestion is associated with long-term sequelae in the form of esophageal and/or gastric cicatrization requiring endoscopic or surgical intervention. Quality of life (QoL) and disability in patients with caustic-induced sequelae is less explored. METHODS: In this prospective study, we included consecutive patients with symptomatic caustic-induced esophageal stricture undergoing endoscopic dilatation. QoL was measured using the World Health Organization Quality of Life questionnaire (WHOQoL-BREF). Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Subjective dysphagia score was calculated by Likert scale. RESULTS: A total of 42 patients were included in the study; 25 (59.5%) patients were male. Patients had poor WHOQoL-BREF and WHODAS scores compared to normality data in all domains of the scores among both the genders. A majority (66.7%) of patients had a current psychiatric diagnosis, with the most common being mood disorder (50%) followed by suicidality (45.2%). Males had a higher prevalence of a previous psychiatric diagnosis compared to females, while females had a higher prevalence of suicidality. Dysphagia score had strong correlation with the WHOQoL (r = -0.66; P < 0.01) and WHODAS (r = 0.71; P < 0.01). CONCLUSION: Patients with esophageal stricture due to caustic ingestion on long-term endoscopic dilatation have poor QoL, high prevalence of psychological morbidity, and disability.

Management of a Psychiatry Inpatient Unit During the COVID-19 Pandemic: An Audit of Services.

Objective: To evaluate the demographic and clinical profiles of patients admitted to the psychiatry ward during the coronavirus disease 2019 (COVID-19) pandemic and compare with profiles of patients admitted 1 year before the onset of the pandemic (ie, before the lockdown announcement in India). An additional objective was to evaluate the incidence of COVID-19 infection in the psychiatry inpatient unit and discuss the measures taken to run the unit during the pandemic, including the measures taken if any patient or staff member was detected to have COVID-19 infection.Methods: This retrospective study was conducted in a tertiary care hospital in North India. Data of patients admitted to the inpatient unit from March 24, 2019, to March 23, 2020, were compared with data from March 24, 2020, to March 23, 2021. The data were extracted from the inpatient registry.Results: Compared to the pre-pandemic period, fewer patients were admitted during the pandemic, and the patients admitted had more severe illness. During the ongoing pandemic, the incidence of COVID-19 infection among the residents was 5%, nursing staff was 4.7%, and support staff was 6.66%. The incidence rate of COVID-19 among the patients was 3.2%. Patients were not found to be the primary source of infection; on the other hand, COVID-positive status among the health care professionals was responsible for patients becoming infected.Conclusions: During the ongoing COVID-19 pandemic, psychiatry inpatient facility can be managed with reduced capacity and by following COVD-19 protocol.

Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India.

BACKGROUND: Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. AIM: To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. MATERIALS AND METHODS: A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention - 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital - baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. RESULTS AND CONCLUSIONS: Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.

A study of emotional states in candidates undergoing the diagnostic process for COVID-19.

BACKGROUND: Waiting for results is often associated with a state of anxiety and restlessness. The current study is intended to study the emotional state of people waiting for their results after undergoing COVID-19 testing. METHODS: A descriptive study was done among 140 participants enrolled by simple random technique over a period of 1 month in May 2020. The participants who gave sample for COVID-19 were assessed for their emotional state at two stages - after giving sample and during the waiting period before telling results to them. A self-designed questionnaire focusing on the demographics and emotional state was submitted by the participants distributed to them as Google Forms. Wilcoxon signed-rank test and McNemar test were used to compare the statistical change in emotions over a period of time. RESULTS: Around 63.6% and 68.8% of the participants had neutral emotional state after giving sample and before announcement of results, respectively. The mean score of agreement with decision to test was 9 ± 1.6 and discomfort related to testing was 4.6 ± 2.6 on Likert scale of 1-10. A statistically significant difference (P = 0.01) was observed in mean response for "something can be done to help" after giving sample (1.6 ± 0.4) and before announcement of results (1.8 ± 0.3). CONCLUSIONS: Patients undergoing testing for COVID-19 undergo psychological turmoil and use various coping methods. Patients endorsed various suggestions including quicker generation of results, environmental changes and counselling services to help them cope better. Incorporating these suggestions may improve the diagnostic process in patients with COVID-19.

The impact of working in a COVID hospital on sexual functioning in male nurses: A study from North India.

INTRODUCTION: The COVID-19 pandemic has spread to almost all the countries and regions in the world. The fear of getting infected while serving COVID patients and the stress due to separation from family during the quarantine period may impact over sexual functioning of healthcare workers (HCWs). METHODOLOGY: The study protocol was approved by the institutional ethics committee. This was a nonfunded, cross-sectional, observational study. All participants provided written informed consent. This study was carried out in a multispecialty tertiary teaching hospital in North India. The participants were drawn from married and living with partner male nurses. Sexual functioning was assessed using the changes in sexual functioning questionnaire short-form (CSFQ-14). RESULTS: The study found that the prevalence of global sexual dysfunction was significantly higher in male nurses who had completed their rotations in the COVID hospital when compared to those who had not. There were no statistically significant differences between the groups on sociodemographic profiles and the profile of their spouses. DISCUSSION: HCWs working in COVID situations are known to suffer from stress, depression, and anxiety. This may impact the sexual functioning of the HCWs, especially when they have been in an infectious environment and the marital dyad may have doubts of the transmission of the infection. CONCLUSION: Male nurses who have worked in a COVID care setting are likely to report higher levels of sexual dysfunction.

Prevalence of Depression and Anxiety during the COVID-19 Pandemic among the Residents of an Urban Slum in North India.

Objectives This study aimed to estimate the prevalence of depression and anxiety, and assess the knowledge, practice, and concerns regarding coronavirus disease 2019 (COVID-19) among the residents of an urban slum in Chandigarh, India. Materials and Methods Participants were screened using Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. Results The mean (standard deviation) age of 200 enrolled participants was 33 (13) years with 83% ( n = 166) being females. The prevalence of depression and anxiety was 3.5% (95% confidence interval [CI]: 0.95-6.05) and 2.5% (95% CI: 0.34-4.66), respectively. Of total, 46% ( n = 92) knew that COVID-19 can transmit through droplets and 30.5% ( n = 61) were concerned that they might get infected with disease. Half of the participants ( n = 100) believed that there was unnecessary worry regarding COVID-19 and 78% ( n = 156) covered mouth while coughing or sneezing. Conclusion To cope with this critical situation, it is necessary to strengthen the awareness programs targeting the mental health issues of the people.

Mental health literacy and familiarity with the term schizophrenia in a community health care setting in North India.

INTRODUCTION: Mental health literacy (MHL) is an important mediator of mental health in the community. Recognition of schizophrenia by the presentation of a case vignette is often used to assess MHL. Various studies assessing MHL around the world have shown that the recognition of schizophrenia is low. This study was designed to use the case vignette method to assess the MHL in a sample of respondents in North India. METHODOLOGY: We translated a well-known case vignette of schizophrenia from english into hindi. A cross-sectional study design was followed. This case vignette was presented in the written format to 200 respondents in rural Punjab and Haryana. The case vignette was followed by questions regarding the identification and nature of the problem, what could be done about it and the familiarity of the respondent to the term 'schizophrenia'. The results were analysed through open coding. RESULTS: Around 22% of the responses identified mental illness. The recognition of schizophrenia by name was only in one response. Most people attributed the condition of the protagonist in the case vignette to be due to stressful life situations. The respondents used the terms 'depression' and 'tension' as descriptors of mental illness. The correction of situations leading to stress and counselling by a psychiatrist was considered by most respondents to be useful. The familiarity with schizophrenia was 18%. CONCLUSIONS: MHL in our sample was low. Measures for improving the MHL in the community are needed. There may be a case for easier nomenclature with regards to MHL.

Prevalence of metabolic syndrome in psychiatric inpatients in a tertiary care centre in north India.

BACKGROUND & OBJECTIVES: Metabolic syndrome (MS) is associated with major mental illnesses. It is a major predictor of mortality and morbidity. This research was undertaken to study the prevalence and correlates of MS in psychiatric inpatients in a tertiary care hospital in north India. METHODS: Consecutive adult patients with a primary psychiatric disorder admitted to the psychiatric ward during the study period (July-December 2007) were evaluated for prevalence of MS as per the criteria of the International Diabetes Federation (IDF). RESULTS: Among the 90 patients included in the study, the prevalence of MS as per IDF was 37.8 per cent and it was significantly associated with the body mass index (BMI). INTERPRETATION & CONCLUSIONS: The present findings showed a higher prevalence of MS in psychiatric inpatients than that in the general population. Further studies on a larger sample need to be done before advising evaluation for the presence of MS in all psychiatric patients.

Does electroconvulsive therapy cause brain damage: An update.

Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage. This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods. These include structural, functional, and metabolic neuroimaging; body fluid biochemical marker studies; and follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain. However, there is a lack of evidence at present to suggest that ECT causes brain damage.

The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India.

BACKGROUND: Most countries around the world have been affected by the COVID-19 pandemic. Although there are quantitative studies on the effects of the COVID-19 pandemic on health-care professionals and other population groups, there are few studies that have evaluated the experiences of patients in the initial phases of the pandemic. AIM: This study aims to conduct a qualitative study assessing the experiences of the patients in isolation and quarantine in the initial stage of the COVID-19 pandemic. METHODOLOGY: The present study was a qualitative study through telephonic interviews with patients in isolation and quarantine due to COVID-19 from April 4 to 12, 2020. Patients in isolation had confirmed COVID-19 and were mandatorily admitted in specially designated COVID hospitals. Patients in quarantine were suspected to have COVID-19 due to symptoms or contact with confirmed patients with COVID-19. RESULTS: The experiences could be classified as having psychological impact, interpersonal impact, social impact, behavioral changes and impact on occupational aspects. The experience was predominantly unpleasant and characterized by anxiety, stigma, ostracization, guilt, and worry about the future. CONCLUSION: The experiences of the individuals in both the groups emphasize the importance of addressing psychological stressors. It could be concluded that individuals and their families would accordingly benefit from effective interventions to deal with the negative experiences they have been through due to the present pandemic.