Medication adherence in bipolar disorder: Exploring the role of predominant polarity.

OBJECTIVES: Medication non-adherence is one important reason behind sub-optimal outcome from treatment of bipolar affective disorder (BPAD). Though various reasons behind medication non-adherence have been identified, little is known about the medication adherence patterns across various predominant polarities (PP) in BPAD. METHODS: 100 euthymic patients of BPAD were purposively recruited and the PP were determined. Subsequently, Morisky Medication adherence scale (MMAS); Global Assessment of Functioning (GAF); Oslo Social Support Scale and World Health Organization Quality of Life scale- Brief version (WHOQOL-Bref) were administered. Analysis of covariance (ANCOVA) was done to estimate the difference of scores of MMAS after adjusting for any potential confounders. RESULTS: Overall, 44 patients with manic PP (MPP), 17 with depressive PP (DPP) and 39 with indeterminate PP (IPP) were recruited. It was found that patients who presented with DPP showed significantly higher medication adherence as compared to MPP. CONCLUSION: Knowledge of PP of a patient of BPAD can be useful in anticipating medication adherence and treatment outcome. The major limitations included non-probability sampling, cross-sectional design and limited generalizability of the results.

A prospective study of suicidal behavior in young patients of depressive episodes with hidden bipolarity exposed to selective serotonin reuptake inhibitor.

Background: Treatment of depressive episodes in young patients is challenging owing to several reasons such as poor diagnostic stability and atypical presentation. Evidence regarding treating such patients with antidepressants such as selective serotonin reuptake inhibitor (SSRI) is not clear. Methods: Fifty patients aged 10-24 years diagnosed with depressive episodes and drug-free for at least 3 months were rated on Beck's Depression Inventory (BDI), The Mood Disorder Questionnaire (MDQ), and Beck Scale for Suicidal Ideation (BSS). The scores of BSS and BDI were compared across four timeframes (weeks 0, 2, 4, and 6) for MDQ-positive and negative patients by using the generalized estimating equations model. Results: Patients who were MDQ-positive (11 patients) tended to score higher on BDI (at weeks 2 and 4) and BSS (at weeks 2, 4, and 6) as compared to MDQ-negative patients (39 patients). After being started on SSRI, MDQ-positive patients showed a poorer response as compared to the other group. The small sample size and short follow-up duration were the major limitations. Conclusions: Close clinical monitoring with regular follow-up during antidepressant initiation is recommended to reduce the risk of suicidality.

A prospective hospital-based study on C-reactive protein as a response predictor of antidepressant treatment in drug naïve patients with major depressive disorder.

Background: C-reactive protein (CRP) is an acute phase reactant that is implicated in the pathogenesis of major depressive disorder (MDD), due to its role in the execution of various important neurological events, including neurogenesis, mediation of neural plasticity, and synaptic transmission. Aims: This study was conducted to determine the relationship between the level of CRP to remission rates after antidepressant therapy. Methods: Fifty patients of first episode MDD with no past history of antidepressant exposure and other medical comorbidity were recruited after obtaining consent for Escitalopram therapy. The CRP levels of the patients were evaluated on the day of recruitment and depressive symptoms were monitored using Montgomery-Asberg Depression Rating Scale at weeks 0, 3, 6, and 12. The patients with low (≤10 mg/l) and high (>10 mg/l) CRP levels were compared for time taken to achieve remission using Kaplan-Meier survival analysis. Results: The Kaplan-Meier survival analysis showed a significantly higher proportion of patients with low CRP levels attained remission than patients with higher CRP levels (Log-rank = 7.594; dF = 1; P = 0.006). The age, compliance to pharmacotherapy, and disability did not significantly affect the remission rates of the patients. Conclusion: Our study confirms that higher levels of CRP can lead to poorer remission rates in patients with MDD after antidepressant therapy and can predict treatment resistance.

A Prospective Observational Study on Changes in Intraocular Pressure and Iridocorneal Angle Following the Use of Escitalopram and Amitriptyline.

Background: Depression has emerged as one of the prime morbidities affecting professional and personal lives worldwide. Antidepressants are one of the mainstays of management of depressive episodes. Although antidepressants are considered a safe class of drugs, the studies examining the effects of antidepressant prescription on intraocular pressure (IOP) have shown a propensity to increase IOP, but not consistently. This study aimed to compare the changes in IOP and iridocorneal angle in drug-naïve patients with depressive episodes prescribed escitalopram or amitriptyline. Methods: Overall, 109 patients were recruited, of which 53 were prescribed amitriptyline and 56, escitalopram. A comparison of IOP and the iridocorneal angle at weeks 0, 4, and 8 was done using a two-way repeated-measures analysis of variance (two-way RM analysis of variance). Results: Patients initiated on escitalopram tended to show a higher rise in the IOP (left eye-[F = 3.27; P = 0.04]; right eye [F = 2.47; P = 0.08]). No difference was found in the iridocorneal angles in any of the four quadrants across both eyes. Conclusions: Escitalopram use had an association with an increase in IOP. While initiating patients on antidepressants, clinicians should be aware of this possibility, which can lead to ocular emergencies, and obtain a proper history of ocular morbidities.

Has loneliness and poor resilient coping influenced the magnitude of psychological distress among apparently healthy Indian adults during the lockdown? Evidence from a rapid online nation-wide cross-sectional survey.

BACKGROUND: The burden of psychological distress is increasing with the spread of the pandemic and also with the enforcement of its containment measures. The aim of this research was to determine the proportion of self-reported psychological distress, loneliness and degrees of resilient coping, and to also investigate the relationship of loneliness, coping and other variables with psychological distress among apparently healthy Indians during nation-wide lockdown period. METHODS: A cross-sectional, region-stratified survey using pre-designed pre-tested Google form disseminated via different social media platforms was conducted. A total of 1249 responses were analysed all over India. The form enquired about Socio-demographic profile, awareness on COVID pandemic and cases in the surroundings. UCLA Loneliness scale, Brief resilience and coping scale (BRCS) and Psychological distress scale (K6) assessed self-reported loneliness, coping and psychological distress, respectively. Special regressor technique adjusting for endogeneity and heteroskedasticity was used to extract the average marginal effects. RESULTS: Majority of the respondents were 18-35 years old, male, single and urban residents. News media, social media mostly acted as sources of information regarding COVID related news. Overall, 54.47% (95% CI: 51.39-57.53%) and 38.39% (95% CI: 35.57-41.29%) were reported to be lonely and had low resilient coping ability respectively. Around 44.68% had high risk of developing psychological distress. Being a student (average marginal effect coefficient (AMECoef).: -0.07, 95% CI: [-0.12, -0.01]) and perceiving lockdown as an effective measure (AMECoef: -0.11, 95% CI: [-0.19, -0.03]) were protective against psychological distress. Psychological distress was associated with male respondents (AMECoef 0.07, 95% CI: [0.02, 0.11]), low or medium resilient copers (AMECoef 0.89, 95% CI: [0.17, 1.61]), and perceiving a serious impact of social distancing measures (AMECoef 0.17, 95% CI: [0.09, 0.26]). CONCLUSIONS: Psychological distress among Indian population during lockdown was prevalent. Poor coping ability and perceiving social distancing to have a serious impact was found to be significantly contributing to psychological distress. Appropriate measures to address these issues would be beneficial for the community mental health.

Correlates of insomnia among the adults during COVID19 pandemic: evidence from an online survey in India.

BACKGROUND: Psychosocial distresses are often associated with sleep disorders. This is found as a common population level observation during natural calamities or emergency situations like a pandemic. The current study was conducted to determine the magnitude of self-reported insomnia, and to identify its associated factors among the apparently healthy Indian adult population having access to social media during the lockdown period of COVID 19 pandemic. METHODS: A cross-sectional, region-stratified survey was conducted from April 20 - May 19, 2020 in India using online questionnaire comprising Perceived Stress Scale, Generalized Anxiety Disorder Scale, Insomnia Severity Index, variables related to concern, fear and apprehension about COVID19 pandemic, and different socio-clinical variables. The questionnaire was disseminated via different social media platforms and responses from 1081 respondents were included in the analysis. RESULTS: Moderate clinical insomnia was present in 13.32% (95% confidence interval [CI]: 12.23%-14.50%), and severe clinical insomnia was present in 1.85% (95% CI: 1.08%-3.14%). For higher levels of insomnia mild anxiety was associated with a proportional odds ratio (OR) of 1.83 (95% CI: 1.24-2.71), and moderate and severe anxiety had an OR of 4.01 (95% CI: 2.57-6.25). Factors associated with higher severity of insomnia were middle age group (36-50 years), being a professional, living alone, perceiving COVID as serious disease, urban residence and those having comorbidity. The OR for being concerned for staying indoors was 5.09 (95% CI: 4.09-5.33), whereas the OR for fear of scarcity in availability of masks and sanitizers was 1.48 (95% CI: 1.26-1.75); and the OR for fear of unavailability of essential goods was 3.20 (95% CI: 2.06-4.98). CONCLUSIONS: Psychosocial factors like generalized anxiety, higher age, higher perceived severity, and various concerns related to COVID19 pandemic were identified to be associated with higher degrees of insomnia. Necessary psychosocial interventions, may be required to address the burden of insomnia in a timely and long-term mode.

Validation of revised reading the mind in the eyes test in the Indian (Bengali) population: A preliminary study.

BACKGROUND: Social cognition deficits are common in clinical populations but there is a dearth of standardized social cognition assessment tools in India. Theory of mind (ToM) is an important aspect of social cognition which is often assessed with the revised reading the mind in eyes test (RMET-R). However, we do not have a statistically validated version of the test for the Indian population. AIM: This study aims to assess the acceptability, reliability, and validity of the Bengali version of the RMET-R. MATERIALS AND METHODS: We administered the RMET-R to 23 patients with chronic schizophrenia (SCZ), 22 patients with bipolar disorder, and 104 healthy controls (HCs) to evaluate the reliability and validity of the instrument in the Indian (Bengali) population. RESULTS: We obtained moderate internal consistency (Cronbach's alpha = 0.6) and test-retest reliability (intraclass correlation coefficient = 0.64, P < 0.001). Positive correlations were found between RMET-R and Wechsler picture arrangement (r = 0.60, P < 0.001), picture completion (r = 0.54, P < 0.001), and comprehension subtests (r = 0.48, P < 0.001). Patients with SCZ (M = 49.7, standard deviation [SD] = 16.5) scored significantly lower than HCs (M = 68.9, SD = 13.8) (P = 0.008; Cohen's d = 1.3) on the RMET-R. Thus this tool could discriminate patients who are reported to have Theory of Mind deficits from healthy controls. CONCLUSION: The Bengali version of the RMET-R is a reliable and valid tool for assessing first-order ToM insofar as the original RMET-R measures this construct.

Storage, Degradation, and New Connectivity of Face-Related Semantic Memory in Alzheimer's Disease.

BACKGROUND: Excepting amnesia, impairment of other domains also hampers the activity of daily living in Alzheimer's disease (AD). Although prosopagnosia poses problem in interacting with other persons, it rarely causes problem during interaction with close relatives as known voice acts as cue for recognition. OBJECTIVE: In a cohort of AD, we planned to study errors in recognition, naming, and assigning relationship of close relatives, to assess the type and frequency of errors and to explain with current knowledge and hypothesis. MATERIALS AND METHODS: This cross-sectional study was conducted in Memory Clinic of Medical College Hospital, Kolkata, India, between July 2013 and June 2015. Patients were evaluated by history, general neurological examination, and neuropsychological tests. A structured questionnaire was used to assess recognition (use of honorifics) and naming defect of close relatives. RESULTS: AD was diagnosed in 42 patients. Prosopagnosia was found in 14 and anomia in 6 patients. Four patients exhibited problem during conversation with close relatives. They assigned name and relation of one generation earlier to close relatives with proper recognitions. DISCUSSION: We got predictive error of name and relation assignment of close relatives by one generation back with normal recognition. It can be explained by two memory traces in connection of face-visual and name (with/without relation) representation, earlier being hierarchically older and more resistant to wearing. CONCLUSIONS: We hypothesize that the name/relation store is orderly conserved. In AD, after degradation of part of name/relation store, a new wiring might be built up between these two traces.