Neurocognitive Functions After 6-Month Buprenorphine (Naloxone)-Based Opioid Agonist Maintenance Treatment: A Controlled Prospective Study.

BACKGROUND: Medications for opioid use disorder (OUD) may influence neurocognitive functions. Inadequate power, confounders, and practice effects limit the validity of the existing research. We examined the change in cognitive functions in patients with OUD at 6-month buprenorphine (naloxone) posttreatment and compared the cognitive performance of the buprenorphine-treated group with control subjects. METHODS: We recruited 498 patients with OUD within a week of initiating buprenorphine. Assessments were done twice-at baseline and 6 months. Those abstinent from illicit opioids and adherent to treatment (n = 199) underwent follow-up assessments. Ninety-eight non-substance-using control subjects were recruited from the community. The neurocognitive assessments comprised the Wisconsin Card Sorting Test, Iowa Gambling Task, Trail-Making Tests A and B (TMT-A and TMT-B), and verbal and visual N-Back Test. We controlled for potential effect modifiers. RESULTS: Twenty-five of the 32 test parameters significantly improved with 6 months of buprenorphine treatment; 20 parameters withstood corrections for multiple comparisons (P < 0.001). The improved test domains spread across cognitive tests: Wisconsin Card Sorting Test (perseverative errors and response, categories completed, conceptual responses), TMTs (time to complete), verbal and visual N-Back Tests (hits, omission, and total errors). After treatment, OUD (vs control subjects) had less perseverative response and error (P < 0.001) and higher conceptual response (P = 0.004) and took lesser time to complete TMT-A (P < 0.001) and TMT-B (P = 0.005). The baseline neurocognitive functions did not differ between those who retained and those who discontinued the treatment. CONCLUSION: Cognitive functions improve in patients with OUD on buprenorphine. This improvement is unlikely to be accounted for by the practice effect, selective attrition, and potential confounders.

A comparative study of retinal layer changes among patients with schizophrenia and healthy controls.

AIM: This study aimed to evaluate the retinal nerve fibre layer changes among different group of patients with schizophrenia and compare it with healthy controls by using swept-source optical coherence tomography. METHODOLOGY: Patients with first-episode schizophrenia (n = 21) in remission (n = 35) or with treatment-resistant schizophrenia (TRS) (n = 35) and 36 healthy controls were evaluated for retinal thickness. RESULTS: Patients with psychotic illnesses had significantly lower sub-foveal choroidal thickness (effect size 0.84-0.86), when compared to the healthy controls. When patients with first-episode schizophrenia were compared with patients with TRS, TRS patients had significant lower sub-foveal choroidal thickness (left eye) when the various confounders (such as age, gender, duration of treatment, smoking, current medications, body mass index, waist circumference, blood pressure, fasting glucose, HbA1c, presence or absence of metabolic syndrome) were taken into account. When the patients with TRS were compared with healthy controls, initially significant differences were observed for the macular volume (left and right) and the ganglion cell thickness (right eye) but these differences disappeared after controlling for the various covariates. CONCLUSIONS: Compared to healthy controls, patients with schizophrenia, psychotic illnesses have thinning of the retina, especially in the sub-foveal choroidal thickness.

White Matter Microstructure and Gray Matter Volume in Cannabis-Induced Psychosis and Schizophrenia With Cannabis Use.

OBJECTIVE: This study explored the differences in white matter (WM) microstructural integrity and gray matter (GM) volume between cannabis-induced psychosis (CIP) and schizophrenia with cannabis use (SZC). METHODS: This cross-sectional study with convenience sampling involved three groups of 20 participants each (CIP, SZC, and a control group without substance use), matched on age, handedness, and education. CIP and SZC were diagnosed with the Psychiatric Research Interview for Substance and Mental Disorders. Diffusion tensor and kurtosis imaging were done, and fractional anisotropy (FA), mean diffusivity, and mean kurtosis were estimated. GM volume was measured with voxel-based morphometry. RESULTS: Group comparisons revealed comparable age at initiation and duration and frequency of cannabis use between participants in the SZC and CIP groups. Participants with SZC had lower FA than controls in the anterior and retrolenticular internal capsule limbs, cingulate gyrus hippocampal formation, fornix, and superior fronto-occipital fasciculus (all p<0.05). Participants with CIP had lower FA than controls in the left fornix and right superior fronto-occipital fasciculus but higher FA than those with SZC in the left corticospinal tract (all p<0.05). On morphometry, participants with CIP had greater cerebellar GM volume than those with SZC and greater inferior frontal gyrus volumes than controls (all p<0.05). CONCLUSIONS: Widespread WM microstructural abnormalities were observed in participants with SZC, and fewer but significant WM disruptions were observed in those with CIP. Better WM integrity in some WM fiber tracts and greater GM volumes in crucial brain areas among those with CIP may have prevented the transition to schizophrenia.

Misconceptions Related to Covid-19 Infection Among the Medical Students During the Early Part of the Covid-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to widespread controversies related to the transmission, treatment, prevention, and management of COVID-19 infection. Medical students have been involved in patient care across the globe and many a times the general public looks forward towards the medical professionals to get proper information about various issues related to COVID-19. We aimed to evaluate the knowledge and misconceptions held by the medical students on various aspects of COVID-19 infection. SUBJECTS AND METHODS: An online cross-sectional survey was conducted through the Survey Monkey® platform using the Whatsapp®, among the medical undergraduate students of a tertiary care Institute of Eastern India. RESULTS: 236 medical students (of different years of medical training/MBBS) participated in the survey and the response rate to the survey was 47.2%. The mean age of the participants was 20.91 (SD-1.86) years, and about three-fifths were males (58.5%). One-third students were either in their first year of MBBS (31.8%) or the final year (35.16%) of MBBS. Incorrect beliefs related to various preventive aspects, risk of increasing chance of getting infection and modes of spread of infection were present in a significant proportion of students, with a wide variation for specific issues. When the number of participants with at least one incorrect related to any of the aspects of COVID-19 infection was evaluated, it ranged from 59% to 85% in different domains. CONCLUSIONS: This survey highlights the widespread prevalence of misconceptions about various aspects of COVID-19 among medical students, which needs to be addressed by proper education and awareness.

Do neurocognitive functions in cannabis induced psychosis groups differ from schizophrenia with cannabis use? A controlled cross-sectional study.

OBJECTIVE: Cannabis-induced psychosis (CIP) has received little research attention. We compared neurocognitive functions in CIP, Schizophrenia with cannabis use (SZC) and healthy control group (CG). METHODS: Twenty age, education, and handedness-matched participants were recruited in each of the three groups. CIP and SZC were diagnosed with Psychiatric research interviews for substance use and mental disorders. Level of cannabis exposure, global intelligence, executive function, attention, vigilance, working, and verbal memory, and motor speed were compared by analysis of variance with post-hoc Scheffe's test. We did a post-hoc power calculation. RESULTS: Age at initiation, frequency, duration, and preparation of cannabis use did not differ significantly between CIP and SZC. CIP performed significantly better (than SZC) in tests of general cognitive ability or intelligence and attention, perceptual tracking and sequencing. SZC showed significant dysfunctions (than CG) in all parameters of the tests for executive dysfunction, sustained attention, short-term verbal memory and psychomotor functioning. CIP and CG did not differ in any cognitive domains except for non-perseverative errors in the test for executive functioning. CONCLUSIONS: CIP and SZC had different degrees of impairment compared to controls, but on direct comparisons CIP had better general intelligence and attention.KEY POINTSCannabis-induced psychosis (CIP) may have different neurocognitive impairment than Schizophrenia with cannabis use (SZC)CIP performed better in tests for general intelligence and visual attention than SZCSZC had significant impairment in executive function, attention, verbal memory, and psychomotor speed than controlsCompared to controls, CIP performed significantly worse in some domains of executive functionCIP and SZC had different degrees of cognitive impairments as compared to the controls.

Evaluation of practice effect on neuropsychological measures among persons with and without HIV infection in northern India.

An evaluation of the effects of HIV infection on neurocognition over time is important for understanding disease progression. Changes in cognitive function can be evaluated longitudinally by using neuropsychological testing at repeated intervals. The assessment of change over time, however, is complicated by the potentially confounding influence of learning on repeated test administrations, often referred to as practice effect. In this study, we present data on testing of persons with or without HIV infection on a battery administered at study baseline and repeated 1 year later. Results suggest that practice effects may be diminished in persons with HIV infection compared to without it. This appears to be true even among those with relatively intact immune functioning as measured by CD4 count.

Neuropsychological test performance among healthy persons in northern India: development of normative data.

Accurate identification of neurocognitive impairment associated with HIV infection (and other CNS-involved conditions) is dependent upon utilization of appropriate normative neuropsychological test performance data from healthy individuals with a similar background, culture, and characteristics of the target individual or group to be tested. In India, regional differences in language, culture, and availability of resources can significantly affect performance on neuropsychological testing. This study developed age- and education-adjusted normative data for commonly used neuropsychological test scores for use in northern India.

Comprehensive questionnaire for assessment of Dhat syndrome: development and use in patient population.

INTRODUCTION: Dhat syndrome is a culture-bound syndrome, characterized by the core belief of loss of semen accompanied by symptoms of general weakness, lack of energy and concentration, impaired sexual functions, and vague somatic troubles, often associated with an anxious or dysphoric mood state. Although many studies have described the clinical picture of Dhat syndrome, there is lack of availability of an instrument which can comprehensively assess patients presenting with Dhat syndrome. AIM: The aim of this article is to develop a questionnaire that can comprehensively assess Dhat syndrome and guide the clinicians in managing such patients. METHODS: Initially, an extensive literature review was done to prepare a comprehensive list of clinical features, beliefs associated with the passage of "Dhat," and attribution of the symptoms by the patients. These items were converted into a questionnaire for investigational interview. The questionnaire thus developed was administered to 54 patients and was also sent to eight subject experts for their opinion on the questionnaire. MAIN OUTCOME MEASURE: To develop and evaluate the content validity of the Comprehensive Questionnaire for Assessment of Dhat Syndrome. RESULTS: As per the opinion of experts, the questionnaire had good content validity and was useful for not only clinicians dealing with patients of Dhat syndrome but was also considered useful for the patients presenting with Dhat syndrome. All the experts found the questionnaire to be comprehensive, and two-third of the experts regarded the length to be adequate. Although none of them suggested any deletion of items, yet some additions were suggested. The language of the questionnaire was rated from simple to very simple. Results of administration of the questionnaire on 54 patients of Dhat syndrome established that the questionnaire was helpful in providing comprehensive clinical picture of Dhat syndrome. CONCLUSION: The questionnaire designed for the purposes of this study is a useful instrument for comprehensive assessment of the clinical picture of Dhat syndrome.

Neurocognitive Dysfunctions in People with Concurrent Cannabis Use and Opioid Dependence: A Cross-Sectional, Controlled Study.

Cannabis and opioid co-dependence is independently associated with cognitive impairments. We examined neurocognitive dysfunctions in people with concurrent opioid dependence with cannabis dependence (OD+CD) or cannabis use (OD+CU) compared to those with only opioid dependence (OD) and healthy controls (HC). We selected adult participants, any sex, who met the diagnosis of OD (N = 268), OD+CU (N = 58), and OD + CD (N = 115). We recruited 68 education-matched HC. We administeredStandard progressive matrices (SPM), Wisconsin card sorting test (WCST), Iowa gambling task (IGT), Trail making tests A and B (TMT), and verbal and visual working memory 1-, 2-backtests. 496 (97.5%) were men, and 13 (2.5%) were women. In WCST, OD and OD+CD had significantly higher non-perseverative errors than HC. OD+CD group completed significantly lesser categories than HC. In verbal working memory 2-back, HC scored significantly fewer errors than OD and OD +CD. All patient groups, OD, OD+CU, and OD+CD, scored higher commission errors than HC in visual working memory 1-back. OD and OD+CD scored higher commission and total errors than the controls. OD+CU showed lesser error score than HC in TMT B. Cannabis and opioid co-dependence contribute to cognitive impairments, especially in working memory and executive functions.

Reducing sexual risk behavior among high-risk couples in Northern India.

BACKGROUND: With a population of 1.1 billion, India is considered to be a country in which effective prevention interventions could contain the development of a human immunodeficiency virus (HIV) epidemic. Heterosexual transmission accounts for 85 % of the extant HIV infections. PURPOSE: This study sought to assess the feasibility of conducting a group, culturally tailored behavioral intervention and its impact on sexual barrier use, self-efficacy, knowledge, conflict resolution, and coping among high-risk heterosexual couples in Northern India. METHOD: This pilot study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India from February 2008 to January 2009. Thirty sexually active high-risk couples were drawn from a convenience sample of PGIMER patients attending infectious disease and family planning clinics. Couples participated in 1 month of three weekly gender-concordant behavioral intervention groups and were individually administered assessments preintervention and post-intervention. The intervention was tailored to the Northern Indian context and addressed sexual barrier use, human immunodeficiency virus (HIV)/sexually transmitted infection transmission, and cognitive behavioral skill building focusing on sexual negotiation and communication. RESULTS: The participants had a mean age of 32 years (men) and 29 years (women), and the majority had at least 10 years of education. At baseline, the majority reported inconsistent condom use (<100 % of the time; 64 % of women, 59 % of men). Post-intervention, nearly all participants reported consistent condom use (100 % of the time; 100 % of men, 97 % of women). Participants also reported decreased verbal aggression, increased self-efficacy, and increased HIV-related knowledge, and women increased their use of positive coping tactics. CONCLUSIONS: The results highlight the potential to successfully utilize a group intervention to discuss sensitive issues such as sexual risk behavior among both men and women. Strategies to improve condom use and communication without increasing intimate partner violence in high-risk couples may be an important adjunct to preventing the development of a generalized epidemic in India.

Prevalence of loneliness and its correlates among patients with schizophrenia.

BACKGROUND: There are limited data on loneliness and its correlates in patients with schizophrenia. OBJECTIVE: To evaluate prevalence and correlates of loneliness in patients with schizophrenia, currently in clinical remission. METHODOLOGY: A total of 160 patients of schizophrenia in clinical remission were assessed on UCLA Loneliness Scale, Positive and Negative syndrome scale, Calgary Depression Scale for Schizophrenia (CDSS), Internalized Stigma of Mental Illness Scale, Rosenberg Self-esteem Scale, Brief COPE, Beck's Hopelessness Scale, Brief Dyadic Scale of Expressed Emotions, and Self-report Quality of Life Measure. RESULTS: The mean age of the study sample was 34.99 (SD = 9.13) years. The prevalence of loneliness in the study sample was 80%, with mean total UCLA-loneliness scale score of 30.04 (16.9).Compared to participants without loneliness, those with loneliness had had higher CDSS score, had poor quality of life, lower self-esteem, experienced higher level of stigma, more often used maladaptive coping strategies such as self-blaming and reported a higher level of hopelessness. In the correlation analysis, higher level of loneliness was associated higher severity of depression, higher level of stigma (except for stigma resistance) and discrimination, poorer quality of life, lower self-esteem, perception of a higher level of expressed emotions, higher use of maladaptive coping in the domains of behavioral disengagement, and self-blaming, and a higher level of hopelessness. In regression analysis, the maximum variance of loneliness was explained by quality of life score (29%), followed by hopelessness score (8.8%) and discrimination score (2%). CONCLUSION: There is a high prevalence of loneliness in patients with schizophrenia, and there is a need to routinely evaluate the patients of schizophrenia for loneliness and address the same.

Psychological/Personal recovery and its correlates in patients with first episode psychosis.

BACKGROUND: Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. AIM: To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. METHODOLOGY: One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. RESULTS: The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. CONCLUSION: The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Antenatal depression and anxiety in Indian women: A systematic review.

There is good evidence to suggest that high prevalence of depression and anxiety in the postpartum period. However, very few studies have focused on antenatal depression and anxiety disorders and their associated risk factors. Further, there are only a handful of studies from India on common antenatal mental health disorders. With this background, we reviewed the existing evidence on antenatal depression and anxiety from the studies conducted in Indian pregnant women during the antenatal period and to explore the associated risk factors. All the major databases were searched systematically for English language studies on prevalence and risk factors for antenatal depression and anxiety in Indian pregnant females, published during the period January 2000 to May 2022. Quality assessment of studies was done with the modified version of Newcastle Ottawa Scale for cross-sectional studies. We found the overall prevalence of antenatal depression was ranged from 3.8% to 65% and antenatal anxiety from 13 to 55%. The most relevant risk factors associated with antenatal depression and anxiety during pregnancy were preference to have a male child, intimate partner violence, history of abortions, marital conflict, poor relationship with the husband/in-laws and lack of social support. To conclude, the systematic review suggests that depressive and anxiety disorders are quite common in Indian pregnant women in antepartum period with varying prevalence depending on various settings and scales used. Steps should be taken to promote obstetricians for regular mental health screening during the antenatal visits and prompt referral to mental health professionals when suspected.

Heroin use and neuropsychological impairments: comparison of intravenous and inhalational use.

BACKGROUND AND OBJECTIVES: Injection and inhalational heroin use are associated with different levels of brain exposure to heroin and its metabolites and differences in the severity of dependence, which might lead to differential impacts on neuropsychological functions. We examined the difference and the magnitude of difference in the neuropsychological functions between inhalational and injection heroin-dependent subjects and also compared them with healthy controls. METHODS: The study sample comprised three groups: 73 subjects with injection heroin dependence, 74 with inhalational heroin dependence, and 75 healthy controls (HC). We excluded patients with HIV, head injury, epilepsy, and severe mental illness. Neuropsychological assessments were done by Standard Progressive Matrices, Wisconsin Card Sorting Test (WCST), Iowa Gambling Task, Trail-Making Tests A and B (TMT), and Verbal and Visual Memory 1 and 2 Backtests (NBT). We estimated independent effects of the groups on various neuropsychological test parameters, adjusted for age and duration of dependence. RESULTS: In the WCST, the inhalational heroin-dependent group took more trials to complete the first category and had higher scores in the failure to maintain set than controls. The intravenous group had higher total errors than controls in verbal working memory tests and Visual Working Memory 2 Backtest. This group scored higher commission errors in the Verbal 2 Backtest than the controls. The two groups of heroin users differed in failure to maintain set and Verbal Working Memory 2 Backtests. The effect sizes of the group differences were modest. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Either route of heroin use is associated with cognitive impairments; inhalational and injection use involve different cognitive domains.

Bereavement Care Practices Following Stillbirths: Health-Care Provider's Perspective.

Background: Addressing stillbirth is a difficult task and becomes more challenging with a huge burden and skewed doctorpatient ratio. There is a lack of data regarding the knowledge about the bereavement care practices following pregnancy loss and practices being followed by the health-care providers in the Indian context. The objective of this study is to describe the experience, views, and practices of health-care professionals while managing women with stillbirths. Design: Internet-based Monkey Survey. Methodology: An on-line self completion questionnaire was shared with various health care providers via emails and whats app groups. Results: A total of 281 responses of health-care providers were analyzed, and the majority of them were obstetricians. Almost 90% had managed women with stillbirth, but just a third (38.1%) had provided bereavement care. The majority of them felt the lack of a uniform and comprehensive training model for providing bereavement care to such women. Out of 281 participants, 258 (91.8%) believed that health-care providers should have a bereavement care training and support system, whereas only 23 (8.2%) rejected this idea. Conclusion: There is no defined protocol or standards for providing bereavement care to women following stillbirth. Most health-care professionals feel an urgent need for professional training to bridge the gap between the expectations of patients and the care provided.

Psychological Impact of COVID-19 Duties During Lockdown on Police Personnel and Their Perception About the Behavior of the People: an Exploratory Study from India.

To evaluate the psychosocial issues among the police personnel during the COVID-19 pandemic. In a web-based cross-sectional survey, 623 police personnel were evaluated on Patient Health Questionnaire-4 (PHQ-4) and Perceived stress scale (PSS), and a self-designed questionnaire. 10.6% of the police personnel had significant anxiety and 18% have significant depressive symptoms with overall psychological morbidity of 22.2%. Higher age was significantly associated with higher depressive symptoms, total PHQ-4 score, and higher perceived stress. The present survey suggests that a substantial proportion of the police personnel on COVID-19 duty during the lockdown period have significant anxiety, depressive symptoms, and perceive significant stress. There is an urgent need to evaluate the mental health issues and provide psychological support to the police personnel who are considered as faceless warriors of the COVID-19. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-020-00408-8.

Cognitive Deficits in Patients with COVID-19 Infection during Their Hospital Stay: An Exploratory Study.

Background The literature on presence of cognitive deficits in patients recovered from coronavirus disease 2019 (COVID-19) infection is emerging. However, the data on whether cognitive deficits have its onset during the acute phase of illness has not been evaluated extensively. Aim This article estimates the level of cognitive functioning of patients with COVID-19 while they were admitted to COVID-designated wards. Secondary objectives were to assess the influence of medical comorbidities, severity of COVID-19 infection, and depressive and anxiety symptoms on cognitive functioning in patients with COVID-19 infection. Methods Sixty-six clinically stable patients with COVID-19 infection were evaluated during their inpatient stay on Hindi Montreal Cognitive Assessment scale (H-MoCA), Hindi Mini-Mental State Examination (HMSE) scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Questionnaire -7. Results The mean age of the study participants was 39.85 (standard deviation [SD] 16.89) years and the participants were evaluated after 9.34 (SD 4.98; median 9.0) days of being diagnosed with COVID-19 infection. About one-fourth (28.8%; n = 19) of the participants had cognitive impairment on HMSE and about two-fifths ( n = 26; 39.39%) had cognitive impairment as per the cutoff used for H-MoCA. A higher level of cognitive deficits were seen among participants who were older, diagnosed with diabetes mellitus, and those who required oxygen support during their hospital stay prior to assessment. Conclusion Low cognitive score was found in one-fourth (28.8%) to two-fifths (39.9%) of the persons, depending on the assessment scale among those with acute COVID-19 infection. Low cognitive score was more prevalent among the elderly, those with diabetes mellitus, and those who required oxygen support prior to the assessment.

A Simple Infection Prevention 'Bundle' Including Preoperative Bath With Hair-Wash to Reduce Surgical Site Infection (SSI) Following Elective Caesarean and Gynaecological Surgery in India.

Background: Surgical site infections (SSIs) may be reduced by following SSI prevention measures. We assessed the SSI rate following caesarean section (CS) and gynaecologic surgery after implementing a simple SSI prevention bundle including preoperative bath and hair wash. Methods: The study was carried out in two hospitals in North India (Post Graduate Institute of Medical Education and Research [PGIMER] and Civil Hospital CH) from August 2018 to July 2019. The SSI rate during intervention period (9 months) was compared with baseline rate (3 months). Womens' knowledge about SSI was assessed preoperatively and after counselling, postoperatively. Results: The baseline SSI rate after CS (n = 165) was 11.1% at PGIMER and 8.5% at CH. After gynae surgery (n = 172), it was 13% at PGIMER and 11.5% at CH. During intervention, (CS = 585, gynae surgery = 503), SSI rate was reduced significantly at PGIMER (CS: 11.1% to 3.7%, P = 0.048; gynae surgery: 13% to 7.1%, P = 0.027), but not at CH (CS: 8.5% to 8.2%, P = 0.903; gynae surgery: 11.5% to 11.4%, P = 0.984). Three measures were followed more often at PGIMER than at CH: before CS, bath with hair-wash: 99.3% vs 78.5%, P = 0.00, hair-clipper vs razor: 100% vs 5.1%, P = 0.00 and antibiotic prophylaxis ≤120 min: 100% vs 92.4%, P = 0.00; and before gynae surgery, bath with hair-wash: 93.2% vs 71%, P = 0.00, hair-clipper vs razor: 93.6% vs 1.9%, P = 0.00 and antibiotic prophylaxis ≤120 min: 100% vs 80.8%, P = 0.00. Postoperatively, womens' knowledge about SSI prevention improved significantly at the two sites. Conclusion: The reduction in SSI at PGIMER was attributed to better compliance to SSI prevention measures listed above. Counselling women about simple SSI prevention method like preoperative bath with scalp hair wash increased their knowledge about these significantly.

Surface-based brain morphometry in schizophrenia vs. cannabis-induced psychosis: A controlled comparison.

BACKGROUND & AIM: We examined group differences in cortical thickness and surface-parameters among age and handedness--matched persons with cannabis-induced psychosis (CIP), schizophrenia with heavy cannabis use (SZC), and healthy controls (HC). METHODS: We recruited 31 men with SZC, 28 with CIP, and 30 with HC. We used the Psychiatric Research Interview for Substance and Mental Disorders to differentiate between CIP and SZC. We processed and analyzed T1 MR images using the Surface-based Brain Morphometry (SBM) pipeline of the CAT-12 toolbox within the statistical parametric mapping. After pre-processing, volumes were segmented using surface and thickness estimation for the analysis of the region of interest. We used the projection-based thickness method to assess the cortical thickness and Desikan-Killiany atlas for cortical parcellation. RESULTS: We observed the lowest cortical thickness, depth, and gyrification in the SZC, followed by CIP and the control groups. The differences were predominantly seen in frontal cortices, with limited parietal and temporal regions involvement. After False Discovery Rate (FDR) corrections and post-hoc analysis, SZC had reduced cortical thickness than HC in the middle and inferior frontal, right entorhinal, and left postcentral regions. Cortical thickness of SZC was also significantly lower than CIP in bilateral postcentral and right middle frontal regions. We found negative correlations (after FDR corrections) between the duration of cannabis use and cortical thickness in loci of parietal and occipital cortices. CONCLUSION: Our study suggested cortical structural abnormalities in schizophrenia, in reference to healthy controls and cannabis-induced psychosis, indicating different pathophysiology of SZC and CIP.

Correlates of expressed emotions as perceived by patients with bipolar disorder.

AIM: To evaluate expressed emotions (EEs) as perceived by the patients and its correlates among patients with bipolar disorder (BD). METHODOLOGY: One hundred patients diagnosed with BD were assessed on the Perceived Criticism Measure (PCM), Family emotional involvement and criticism scale (FEICS), Brief dyadic scale for expressed emotions (BDSEE) and Vulnerability for abuse screening scale (VASS) to assess EE and possible abuse by the caregivers. Caregivers were evaluated on family burden interview schedule and family coping questionnaire. RESULTS: Longer duration of illness (Pearson's correlation coefficient: -0.335; p = .001***) and longer duration of treatment (Pearson's correlation coefficient: -0.317; p = .001***) were associated with significantly lower perceived criticism as assessed by FEICS. Higher use of coping mechanisms such as coercion, avoidance and resignation by caregivers were associated with the higher perception of EE, whereas the use of coping mechanisms such as information seeking, communication, and social involvement by the caregivers was associated with the perception of lower EE among the patients. Higher caregiver burden was associated with a higher perception of the EE by the patients. Higher perception of abuse by the patients was associated with higher EE. CONCLUSIONS: Present study suggests that higher use of maladaptive coping, caregiver burden, and abuse has a significant impact on the EE. Accordingly, psychosocial interventions need to focus on caregivers to reduce EE.