Association of oxidative stress and inflammatory markers with chronic stress in patients with newly diagnosed type 2 diabetes.

AIMS: Chronic stress is associated with increased risk of type 2 diabetes. Oxidative stress and inflammation are potential mediators of this risk. This study was conducted to investigate the association of oxidative stress and inflammatory markers with chronic stress and newly diagnosed type 2 diabetes. METHODS: Oxidative stress/antioxidant status (malondialdehyde [MDA], reduce glutathione [GSH], glutathione reductase [GR], glutathione peroxidase [GPx], catalase [CAT], superoxide dismutase [SOD]), inflammatory markers (highly sensitive C-reactive protein [hsCRP], adiponectin, leptin), chronic stress levels as assessed by stress scales-presumptive stressful life events scale (PSLES), perceived stress scale (PSS), sense of coherence (SOC) and stress biomarker-salivary cortisol in 125 subjects with newly detected diabetes mellitus (NDDM) were compared with an equal number of age and sex matched subjects with normal glucose tolerance (NGT). RESULTS: NDDM subjects as compared with NGT had significantly increased MDA (P < 0.001), hsCRP (P < 0.001), and leptin (P = 0.014) levels and increased GR (P = 0.043) and SOD (P < 0.001) activity along with decreased GSH (P < 0.001) and adiponectin (P < 0.001) levels. They also had significantly higher PSLES-LT and PSS and lower SOC scores along with elevated levels of 10:00 pm salivary cortisol and post dexamethasone salivary cortisol as compared with NGT. In stepwise logistic regression analysis, variables GSH (OR: 0.805), SOD (OR: 1.004), and adiponectin (OR: 0.771) along with PSLES-LT (OR: 1.007), PSS (OR: 1.147), SOC (OR: 0.667), salivary cortisol 10:00 pm (OR: 1.382), WC (OR: 1.087), and HOMA-IR (OR: 2.721) emerged as significant predictors of NDDM. CONCLUSION: The findings of this study indicate that chronic psychological stress and stress responses are associated significantly with inflammation and oxidative stress, which could act as mediating stress related risk factors for type 2 diabetes.

Qualitative content analysis of cultural formulations of clients suffering from conversion disorder in North India.

Introduction: Conversion disorder is easily one of the least understood neuropsychiatric disorders. There is a great deal of ambiguity with respect to symptom presentation, assessment, etiology, diagnosis, and treatment. However, a common clinical practice associated with the assessment and management of the conversion disorder is the evaluation of a stressor. Recent studies in India have indicated that family stressors are the most frequent. Sociocultural aspects of the client's environment and the illness experience thus form an important part of the client's diagnostic formulation. These aspects also determine help-seeking, treatment adherence, and thus, the outcomes. Materials and Methods: Fifteen clients suffering from conversion disorder in a tertiary mental health setting in North India, recruited through purposive sampling, were interviewed in-depth. Data were elicited using the cultural formulation interview (CFI). Qualitative content analysis was carried out. Results: The content analyses summarized the cultural experiences of clients suffering from conversion disorder under structured domains of the CFI. The results are presented in tables along with content examples and represent individual client experiences and conceptualizations of diagnosis, treatment, and implications of suffering from conversion disorder. The findings of this study aim to describe and highlight the cultural experiences of clients with respect to their psychopathology. The most striking recurrent theme in the cultural formulations were the lack of understanding of the nature and cause of illness both in the client as well as the clinician, and therefore a lack of trust and hope in the treatment. Conclusion: The findings of the current study shed light on the cultural experiences of clients with conversion disorder. These findings emphasize the need for clinicians to incorporate the individual and collective cultural experiences of clients and cultural sensitivity in addition to the clinical diagnoses. The Cultural Formulation Interview of the DSM-5 was found to be very helpful in this regard and we encourage its use by clinicians, especially with clients suffering from conversion disorder, given the strong influences of socio-cultural experiences on psychopathology as well as the intervention.

Indian Academy of Pediatrics Revised Guidelines on School Reopening: First Revision, September 2021.

JUSTIFICATION: The COVID-19 pandemic has affected schooling for more than 24 crores students, since March 2020. Students need a respite from the long standing social isolation so that they regain their chance to develop holistically, but after the devastating effects of the second wave, the administrators as well as parents are skeptical about the decision of school reopening. PROCESS: The Indian Academy of Pediatrics constituted a task force comprising of national and international experts in the field who deliberated on the issue. OBJECTIVES: To bring out scientifically supported guidelines on the prerequisites of opening and attending the schools, in the current context of the COVID-19 pandemic. RECOMMENDATIONS: The task force recommends i) Decentralization of the school reopening decision; ii)Three epidemiological parameters, case positivity rate (<5 or steadily declining number of cases for past two weeks), number of new cases(<20 per lakh population per day for past two weeks) and vaccination coverage (>60% of the vaccine-eligible population) to be met at the local level, before the schools reopen; and iii) Criteria regarding health and vaccination to be met by the schoolattendees.

Socio-cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India.

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men's sexual health - sexually transmitted infections, psychosexual concerns and psychological distress - but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men's urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12- items). Results revealed that local and traditional notions of health influenced men's symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51-4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.

HIV infection and high-risk behaviors in opioid dependent patients: the Indian context.

Various risk behaviors promote the spread of HIV in drug addicts. Reflecting the substantial regional and geographic differences in the impact of HIV, its prevalence rates vary from country to country. In view of increasing reports of injection drug-uses (IDUs) from different parts of India, the study was aimed to examine and investigate the difference in prevalence rates of seropositivity between IDUs and non-IDUs in patients of drug dependence and to compare the pattern of risk behaviors due to sexual and drug use practice in IDUs and non-IDUs. A high HIV seroprevalence of 8.3% between IDUs and 1.8% in non-IDUs was found. The study findings suggest a trend towards drug-related risks being higher than sex-related risks in IDUs.

Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study.

AIM: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. MATERIALS AND METHODS: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India) from January 2009 to December 2010 was undertaken. RESULTS: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35) was the most commonly entertained diagnosis and affective disorder (18%, N=11) being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT). CONCLUSION: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study.

Drug-induced psychosis associated with albendazole-ivermectin combination therapy.

We report a case that experienced psychosis after combination therapy of albendazole and ivermectin. This case report represents the first report of psychosis caused by this combination therapy and its treatment with clonazepam.

Initiating tobacco cessation services in India: challenges and opportunities.

BACKGROUND: Tobacco use contributes significantly to the diseases burden in India. Very few tobacco users spontaneously quit. Therefore, beginning 2002, a network of 19 tobacco cessation clinics (TCCs) was set up over a period of time to study the feasibility of establishing tobacco cessation services. METHODS: Review of the process and operational aspects of setting up TCCs was carried out by evaluation of the records of TCCs in India. Baseline and follow-up information was recorded on a pre-designed form. RESULTS: During a five-year period, 34 741 subjects attended the TCCs. Baseline information was recorded in 23 320 cases. The clients were predominantly (92.5%) above 20 years, married (74.1%) and males (92.2%). All of them received simple tips for quitting tobacco; 68.9% received behavioural counselling for relapse prevention and 31% were prescribed adjunct medication. At six-week follow-up, 3255 (14%) of the tobacco users had quit and 5187 (22%) had reduced tobacco use by more than 50%. Data for three, three-monthly follow-ups was available for 12 813 patients. In this group, 26% had either quit or significantly reduced tobacco use at first follow-up (three-months), 21% at the second (six-months) and 18% at the third follow-up (nine-months) had done so. CONCLUSIONS: It is feasible to set up effective tobacco cessation clinics in developing countries. Integration of these services into the health care delivery system still remains a challenge.

Measurement of cholesterol and triglycerides from a dried blood spot in an Indian Council of Medical Research-World Health Organization multicentric survey on risk factors for noncommunicable diseases in India.

BACKGROUND: Dried blood may be a convenient method of sample collection in epidemiological studies; however, the method needs evaluation in a field settings. In the present study, feasibility of using dried blood for measurement of cholesterol and triglycerides was evaluated in multicenter surveillance study for noncommunicable disease (NCD). METHODS: Samples were collected in a cross-sectional study for NCD risk factor surveillance conducted in six centers in India. For every tenth subject recruited, a blood sample was also collected on filter paper. These 10% serum samples and dried blood spots were analyzed for cholesterol and triglycerides. RESULTS: The mean coefficient of variation (CV) for cholesterol was less than 10% between dried blood and serum in five of the six participating centers. Only one center showed a high CV of 14%. Similarly, the mean bias was less than 10% in five centers. The intraclass correlation between cholesterol values in dried blood and serum were greater than 0.638 in all centers, which suggests a good homogeneity of results. The mean CV for triglycerides ranged from 0.36% to 17.97%. The intraclass correlation between triglyceride values in dried blood and serum ranged from 0.756 to 0.880 in the six centers. CONCLUSION: In conclusion, dried blood would be a good method for collection of blood for measurement of cholesterol and triglycerides for population health surveys. However, the benefits of blood spot analysis should be weighed against potential sources of errors attributable to sampling and other factors, such as temperature and humidity, in a country like India.

Report of the Indo-US health care summit 2009 - Mental health section.

The 2nd Indo-US Health Care Summit held in January 2009 was a forum to discuss collaboration between physicians in the US and India on medical education, health care services and research. Six specialties were represented including Mental Health (MH). Using Depression as the paradigmatic disorder, the following objectives were developed. Objective I - Leadership and Public Education: Linkage with like-minded agencies and organizations. The core message should be simple. Major Depression is a brain disorder. Depression is treatable. Timely treatment prevents disability and suicide. Objective II - Medical Education: To improve psychiatric education, it was proposed that (1) relations between US/UK and Indian mid-level institutions be established, (2) teaching methods such as tele-psychiatry and online courses be pursued, (3) use models of teaching excellence to arouse student interest, and (4) develop core curricula for other branches of medicine, and CME. Objective III - Reduce Complications of Depression (Suicide, Alcoholism): Goals include (1) decriminalizing attempted suicide, (2) improving reporting systems, and including depression, psychosis, alcoholism, and suicide in the national registry, (3) pilot studies in vulnerable groups on risk and interventions, and (4) education of colleagues on alcoholism as a link between psychiatric and medical disorders. Objective IV - Integrating MH Treatment& Primary Health Care: The focus should be on training of general practitioners in psychiatry. Available training modules including long distance learning modules to be suitably modified for India. Collaborations and specific project designs are to be developed, implemented and monitored by each specialty group and reviewed in future summits.

Urban rural differences in prevalence of self-reported diabetes in India--the WHO-ICMR Indian NCD risk factor surveillance.

Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p<0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nation-wide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study.

Pathological fantasy friend phenomenon.

Fantasy friend or imaginary companions is usually regarded as normal phenomenon and commonly seen in children. The index case is presented for highlighting the pathological nature of fantasy friend phenomenon, role of psychological, social and cultural factors in its genesis and its course. Onset and persistence of this phenomenon throughout adolescence, its longer duration and non-recognition of its imaginary component by the patient indicates its pathological nature. The patient developed schizophrenia after experiencing this phenomenon for 12-13 years. It is concluded that pathological fantasy friend phenomenon may carry risk of schizophrenia if continued without any intervention for longer duration. Hence, there is a need to identify and intervene early in such kind of cases. The findings of this case report needs to be corroborated by other case reports or studies.

Prevalence, pattern and predictors of mental health morbidity following an intermediate disaster in an urban slum in delhi : a modified cohort study.

The present study reports on the findings from an ICMR supported Research Project on the mental health consequences and service needs of the population of an urban slum in Delhi affected by an intermediate fire disaster. The study was aimed at examining the prevalence, the pattern and the predictors of mental health morbidity in the disaster affected population. Modified cohort design was used , with a control group, and two stage assessments for the prevalence of psychiatric disorder at two years after the disaster, with GHQ-12 and SCAN based clinical interview with ICD-10-DCR.. The data were analysed using r2 test and independent 't' test for inter group comparison and stepwise logistic regression for finding predictors of psychiatric morbidity and psychological ill health. The prevalence of psychiatric disorders was significantly higher (78/1,000 v/s 22/1,000), and the prevalence of psychological ill health was also higher (232/1000 v/s 50/1000), as compared to the control group. The commonest psychiatric disorders were Depression, Substance Use Disorders, Generalised Anxiety Disorder, and Somatoform Disorders. The commonest symptoms of psychological ill health were suggestive of depression. Age and participation in relief work were found to be strong predictors, and physical injuries were found to be a weak predictor of mental health morbidity. The findings have important implications in the service delivery and research on mental health aspects of disasters, which are highlighted and discussed.

Urban mental health services in India : how complete or incomplete?

The information about Urban Mental Health Services has been nearly nonexistent in India, although the developed countries have been focusing on programmes for "Healthy Cities". The initiative taken as part of the WHO-ICMR Pilot Project on Urban Mental Health Services, with a public health perspective is being shared. The objectives of the Health Services Research (HSR) Arm of the project were to study the distribution and the availability of tertiary Mental Health Services, availability of human resources, average service load, mental health service gap, and perceptions of the users and the service providers, regarding the barriers in accessibility of mental health services, unmet service needs and strategies for improvement.The Research Methods involved Mapping Exercises with estimation of Service Loads and Qualitative Research Methods (QRM) like In-Depth Interviews (IDIs), Key Informant Interviews (KIIs), Free Listing and Focused Group Discussions (FGDs). The results indicate uneven availability of mental health services, human resource deficit specially for non-medical mental health professionals and mental health service gap (82% to96%). The average service load in the specialist mental health services is largely carried by the Govt. sector (half to two thirds), followed by the private sector (one third to half), with only a small portion by the NGO sector. The average mental health service load in the primary care general health services is largely carried by the private sector, with significant contribution from the non-formal service providers. The barriers to access, unmet needs and possible strategies as perceived by the community, users and service providers have been identified. The findings are discussed in the context of the mental health programmes and the public policy issues. The implications of the conclusions which suggest that Urban Mental Health Services are far from complete are highlighted.