Impact of Covid-19 lockdown on the emotional health of schoolchildren in an urban Indian setting.

Background Public health measures taken to prevent the spread of the Covid-19 pandemic can potentially impact the mental health of children. We assessed the prevalence and risk factors for childhood depression during the Covid-19 lockdown. Methods After 100 days of lockdown, we sent a survey questionnaire by WhatsApp to parents of school-aged children (5-16 years) in Chennai. The Short Mood and Feelings questionnaire was used as an objective screening tool to assess depression, with a score of 12 as the cut-off. Results There were 874 responses. The prevalence of childhood depression was 13.7%. Girls were more likely to be depressed than boys; 11-16-year-olds were more likely to be depressed than 5-10-year-old children. Children who had more than 4 hours online education had a higher likelihood of depression. Those who used a cell phone for online classes had a higher likelihood of depression compared to other devices, such as tabs or laptops. Children who slept less than 8 hours a day had a higher likelihood of depression while those who either did not sleep in the afternoon or slept less than 1 hour had a lower likelihood of depression. Children who were interacting with family over 1 hour per day had a lower likelihood of depression. Conclusion Overzealous online education, lack of adequate sleep and failure to spend quality time with the family can negatively impact the mental health of children. The impact of Covid-19 on the emotional health of children should be addressed by public health policy-makers and healthcare professionals.

Yoga and psychiatric disorders: a review of biomarker evidence.

Traditionally, yoga has been used as a means for spiritual growth but over the past two decades or so its therapeutic benefits in psychiatric disorders have been scientifically explored. Yoga has been shown to be useful as a mono-therapy in mild to moderate depression and as an adjuvant in several psychiatric disorders including schizophrenia, anxiety disorders, substance use disorders and Mild Cognitive Impairment. Furthermore, systematic attempts have been made to understand the biological correlates of yoga in these psychiatric disorders. Given that no psychiatric disorder has strong and established biomarkers, it is interesting that preliminary research has demonstrated significant changes in certain important biomarkers following regular yoga practice. In this brief review, we provide an update on the effects of yoga on biochemical, neuro-physiological and neuro-imaging related bio-markers in psychiatric disorders. Although findings and trends are promising, much more research is warranted to establish a definite biological basis for yoga in psychiatry.

Yoga for psychiatric disorders: from fad to evidence-based intervention?

There is growing evidence for yoga's neurobiological effects in people with psychiatric disorders. Postulated mechanisms of action include: (a) modulation of the hypothalamic-pituitary-adrenal (HPA) axis; (b) enhancement of GABAergic neurotransmission; (c) autonomic modulation; and (d) neuroendocrinological effects. Yoga as a therapeutic intervention in psychiatric disorders appears promising and merits further attention in clinical practice and research.

Wellbeing and burnout in medical students in India; a large scale survey.

Medical students in India completed an anonymous online questionnaire regarding mental health and wellbeing, including Oldenburg burnout ratings, CAGE questionnaires, and general health questionnaire (GHQ12). Out of 597 student responses, over 80% were characterised as experiencing burnout. This study highlights the need to further examine this issue, including possible causes and solutions.

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services.

BACKGROUND: Approximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. METHODS: A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support). RESULTS: A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall). CONCLUSIONS: Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. TRIAL REGISTRATION: ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.

Do High School Students in India Gamble? A Study of Problem Gambling and Its Correlates.

Studies from the West suggest that significant numbers of high school students gamble, despite it being illegal in this age group. To date, there have been no studies on the prevalence of gambling among senior high school and higher secondary school students in India. This study reports point prevalence of gambling and its psychosocial correlates among high school students in the State of Kerala, India. 5043 high school students in the age group 15-19 years, from 73 schools, were selected by cluster random sampling from the district of Ernakulam, Kerala, South India. They completed questionnaires that assessed gambling, substance use, psychological distress, suicidality, and symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Of a total of 4989 completed questionnaires, 1400 (27.9 %) high school students reported to have ever gambled and 353 (7.1 %) were problem gamblers. Of those who had ever gambled, 25.2 % were problem gamblers. Sports betting (betting on cricket and football) was the most popular form of gambling followed by the lottery. Problem gamblers when compared with non-problem gamblers and non-gamblers were significantly more likely to be male, have academic failures, have higher rates of lifetime alcohol and tobacco use, psychological distress, suicidality, history of sexual abuse and higher ADHD symptom scores. Gambling among adolescents in India deserves greater attention, as one in four students who ever gambled was a problem gambler and because of its association with a range of psychosocial variables.

Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol.

BACKGROUND: Autopsy studies suggest that Wernicke-Korsakoff syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but uncertainty remains about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience. This is an update of a review first published in 2004 and last updated in 2008. OBJECTIVES: • To assess the efficacy of thiamine in preventing and treating the manifestations of WKS due to excess alcohol consumption. • To determine the optimum form, dose and duration of thiamine treatment for this indication. SEARCH METHODS: ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 6 September 2012 using the term thiamine OR aneurine. ALOIS contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trial databases and grey literature sources. SELECTION CRITERIA: Any randomised trials comparing thiamine with alternative interventions or comparing different thiamine regimens (varying in formulation, dose or duration of administration). DATA COLLECTION AND ANALYSIS: All abstracts were independently inspected by two reviewers (ED and PWB), and relevant articles were retrieved and assessed for methodological quality using criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomly assigned participants (n = 107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5 mg/day) with each of the other four doses. A significant difference favoured 200 mg/day compared with the 5-mg/day dose in determining the number of trials needed to meet inclusion criteria on a delayed alternation test (mean difference (MD) -17.90, 95% confidence interval (CI) -35.4 to -0.40, P = 0.04). No significant differences emerged when the other doses were compared with 5 mg/day. The pattern of results did not reflect a simple dose-response relationship. The study had methodological shortcomings in design and in the presentation of results that limited further analysis. AUTHORS' CONCLUSIONS: Evidence from randomised controlled clinical trials is insufficient to guide clinicians in determining the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of WKS due to alcohol abuse.

Social network support for individuals receiving opiate substitution treatment and its association with treatment progress.

BACKGROUND/AIMS: Social networks have been hypothesized to protect people from the harmful effects of stress, but may also provide dysfunctional role models and provide cues associated with drug use. This study describes the range, type and level of social support available to patients engaged in UK opiate substitution treatment (OST) programmes, and explores the association between network factors and continued use of illicit heroin. METHODS: A cross-sectional survey of a randomly selected sample of OST patients (n = 118) utilised measures of current substance use and social network structure and support. RESULTS: More than half of the participants had used heroin in the previous month, and most described networks that were both supportive and positive about treatment. Multivariate analysis showed that the substance use involvement of network members was higher in those patients still using heroin, even when other treatment factors were controlled for. CONCLUSION: There was a strong association between ongoing contact with other drug users and continued use of illicit heroin in this treatment sample. Whilst there is potential for the involvement of social networks in treatment, future research needs to ascertain the exact nature of the relationship between social support and drug use.

Indian Psychiatric Society multicentre study: Diagnostic patterns, comorbidity and prescription practices for patients with Dementia.

Background: There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle. Aim: This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India. Method: A retrospective case file study was conducted across several centers in India. Results: Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer's disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions. Conclusions: Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided.

Gambling in Malaysia: an overview.

Many forms of gambling are legal and popular in Malaysia. Despite this, in Malaysia, research into gambling is limited and there is no coherent strategy to tackle gambling-related harms. This paper summarises the gambling landscape of Malaysia, law governing gambling and research done so far and gives some recommendations on the way forward.

An overview of gambling in Nigeria.

Gambling, legal and illegal, is popular in Nigeria. Lack of stringent regulation and enforcement, coupled with the rise in online gambling opportunities, has resulted in increased gambling-related harm. There needs to be a multipronged public health strategy to address the harms of gambling and for this the government, gambling industry, policy makers and academic experts need to engage in a meaningful debate.

Family therapy interventions in India for persons with gambling disorder.

Gambling is a popular pastime in India and the number of problem gamblers is on the rise. Although the impact of gambling disorder on families is grossly under-researched in India, drawing on international evidence it is only reasonable to assume that this is an important area deserving further clinical and research attention. Of the several types of interventions possible with families of persons with gambling disorder, in our clinical experience, the 5-step intervention is a feasible and culturally adaptable psychotherapeutic intervention. In this paper we have looked at the theoretical aspects of this intervention and also raise some of the practical challenges of offering psychological interventions to families of persons with gambling disorder in India. Albeit limited, we discuss the evidence base to have emerged from India in this field. Finally, we suggest some intervention measures as the way forward.

Learned Helplessness, Psychological Wellbeing, and Proenvironment Care Behavior among Victims of Frequent Floods in Kerala.

Background In 2018 and 2019, there were floods in the coastal regions of Kerala. Many individuals and families were victims on both these occasions; these floods had devastating impact on individual psychological wellbeing, their financial stability, and on overall family wellbeing. Furthermore, many people in vulnerable geographical areas still live in uncertainty and fear. In this context, our study examined whether continuous victimization of natural calamities, like floods in Kerala, leads to the development of learned helplessness and decreased psychological wellbeing among those affected. We also studied whether proenvironment care behavior increased among flood-affected individuals. Materials and Methods We studied 374 heads of families in Kerala, selected through the Quota sampling method. They belonged to the following three groups: (1) flood-affected only once (OFA, n = 124), (2) flood-affected twice (TFA, n = 124), and (3) never flood-affected (NFA, n = 124) households. The key variables of learned helplessness, psychological wellbeing, and proenvironment care behavior were measured using learned helplessness scale, psychological wellbeing scale, and the environmental behavior scale, respectively. Statistical Analysis The Kruskal-Wallis test was used to analyze the data for independent groups. Results Learned helplessness was found to be high among the TFA group. Psychological wellbeing and proenvironment care behavior were high among the OFA group as compared with the TFA group. The NFA group had higher learned helplessness in comparison to the OFA group, and psychological wellbeing and proenvironment care behavior were low when compared with the TFA group. Conclusion We conclude that surviving a moderate amount of risk is perhaps necessary for better psychological wellbeing and that too many or too few risks in life are detrimental to good psychological health. Immediate psychological support among victims of natural calamities and periodic examination of well-being and psychological interventions among people who are vulnerable for frequent victimization of natural calamities have to part of disaster management related to natural calamities.

Antecedents of the Attitudes Toward Singlehood Among Young Adults in Malaysia, Japan, and India.

With both theories and empirical studies supporting the benefits of having a romantic relationship, there remains an increasing tendency of staying single being documented globally. It is thus important to understand the antecedent factors of such voluntary single movement. Guided by the Investment Model of Commitment (IMC) process, the roles of subjective socioeconomic status (SSES), relational mobility, and desirability of control in attitudes toward singlehood were investigated. A total of 1,108 undergraduate students from Malaysia (n=444), Japan (n=316), and India (n=348) answered an online survey consisting of the Attitudes toward Singlehood Scale, MacArthur Scale of SSES, Relational Mobility Scale, Desirability of Control Scale, Mini-Social Phobia Inventory, and Single Item Narcissism Scale. Hierarchical multiple regression analysis showed a persistent positive relationship between desirability of control, but not socioeconomic status and relational mobility, with attitudes toward singlehood, even after statistically excluding the effects of social anxiety and narcissism. A similar pattern was also observed among those who were currently single. Moreover, an interaction effect of socioeconomic status and relational mobility was found in further exploratory analysis. The results highlight that retaining the autonomy and flexibility of managing one's own life and financial concern are the key reasons young adults prefer staying single to engaging in a romantic relationship. Implications and recommendations for future research are also presented in this study.

Psychometric Qualities Evaluation of the Interdependent Happiness Scale across Malaysia, Philippines, and India.

The nine-item Interdependent Happiness Scale (IHS; Hitokoto & Uchida, 2015) is a self-report of interpersonal happiness that focuses on three dimensions: relationship-oriented happiness, quiescent happiness, and ordinary happiness. Few studies have evaluated the psychometric properties of the IHS in diverse cultural backgrounds and the findings are inconsistent. This study investigated whether the IHS has sound psychometric qualities in three Asian countries. University students from Malaysia (n = 263), Philippines (n = 239), and India (n = 310) answered the IHS and self-rated creativity scale. Confirmatory factor analysis on each sample supported the nine-item second-order model with error covariances. The overall IHS score showed good reliability in all samples. The subscales, however, had mixed results except for the Indian sample. Similarly, the convergent validity test showed mixed results while discriminant validity is supported in all samples except for the quiescent happiness subscale in the Indian sample. Concurrent validity was established across three samples by showing a positive relationship with creativity score. The results highlight that the higher-order structure of the IHS is consistently supported in different cultural contexts. However, some of the items are perceived differently and require further improvement in enhancing the cross-cultural usability of the IHS to measure socially-oriented happiness.

Gaming disorder: what doctors need to know.

Playing video games (online or offline) is not a recent phenomenon and for most people it is a leisure activity with no adverse consequences whatsoever. However, for a small minority, gaming has the potential (akin to substance use) to lead on to problematic gaming and gaming disorder. Gaming disorder is a new entry in both the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. Given gaming's ever-growing popularity, GPs, psychiatrists and other doctors will be increasingly likely to come across individuals who present with gaming-related problems. Consequently, this article gives doctors a basic understanding of what gaming disorder is, its presentations in practice and diagnosis, and its treatment.

Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know.

Attention deficit hyperactivity disorder is a persistent, pervasive neurodevelopmental disorder, characterised by the core features of hyperactivity, impulsivity and inattention. While previously thought to be a condition that only affects children, it is now well recognised that in a significant proportion of cases both symptoms and associated impairment will persist into adulthood. Nevertheless, many cases are missed or misdiagnosed because of the lack of awareness of attention deficit hyperactivity disorder as a potential diagnosis in adults, the number of symptoms that overlap with other psychiatric conditions, and the high rates of comorbidity. However, once correctly diagnosed, attention deficit hyperactivity disorder responds well to treatment, particularly pharmacological intervention. This article gives an overview of attention deficit hyperactivity disorder with special emphasis on the diagnosis and pharmacological treatment of attention deficit hyperactivity disorder in adults.

Tobacco Use Among College Students Across Various Disciplines in Kerala, India.

BACKGROUND: Tobacco use is a major public health concern in India. Its use in young people is linked to increased severity, longer duration, and reduced efforts to seek treatment for tobacco use. A significant proportion of young people are enrolled in colleges, and early prevention during this period has better effectiveness. There is preliminary evidence that prevalence may vary across courses even among students of the same sociocultural background. Hence, we compared the prevalence and correlates of tobacco use among college students enrolled in five common streams of collegiate education (medical, nursing, engineering, arts/science and others, law/fisheries) in Kerala, India. METHODS: 5784 college students from 58 colleges (medical, nursing, engineering, arts, and law and fisheries) selected by cluster random sampling in the district of Ernakulum, Kerala, completed a self-administered questionnaire incorporating standardized instruments. R software was used for analyses. Lifetime prevalence and severity of tobacco use were determined. Sociodemographic variables of tobacco users and nonusers enrolled in various courses were compared using chi-square test and two-way ANOVA. Furthermore, for each course, factors influencing tobacco use were identified using multivariable logistic regression analysis. RESULTS: The mean age of the sample was 19.5 ± 1.9 years, with the majority being female (65.3%). Lifetime prevalence of tobacco use varied from 0.5% in nursing students, 4.2% in medical students, 8.2% in students of arts and science, 12.5% in engineering students, and 22.8% among other students (law/fisheries). Approximately two-thirds of all tobacco users across courses showed signs of nicotine dependence. Dependent users also showed variance with none in nursing, 2.6% among medicine, 1.6% among arts and science, 1.9% among engineering, and 6.3% among others. Male gender and alcohol use were consistently associated with tobacco use across courses, whereas other examined psychosocial correlates showed variance. CONCLUSIONS: To conclude, it appears that among college students, course-level characteristics may influence risk of tobacco use. This has public health importance as it suggests that interventions need to be tailored bearing this in mind. Future research needs to examine campus-level characteristics that may explain variance.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India.

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive-impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.