A qualitative 5-country comparison of the perceived impacts of COVID-19 on people living with dementia and unpaid carers.

BACKGROUND: Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. METHODS: Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. RESULTS: Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. CONCLUSIONS: The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.

A randomized, double-blind, placebo-controlled, 12-week trial of vitamin D augmentation in major depressive disorder associated with vitamin D deficiency.

BACKGROUND: Randomized controlled trials (RCTs) of vitamin D (VitD) supplementation for depression have yielded inconsistent results. We conducted the first RCT of VitD supplementation with multipoint serum 25(OH)D assessments in major depressive disorder (MDD) patients with concurrent severe VitD deficiency. METHODS: We randomized antidepressant-free depressed adults with mean baseline 25(OH)D of 11.5 ng/ml to VitD (60,000 IU every 5 days; n = 31) or placebo (n = 28) for 12 weeks. All patients also received escitalopram (10-20 mg/day). Patients were rated at baseline and at the end of weeks 4, 8, and 12. Serum 25(OH)D was estimated at baseline, week 8, and week 12. RESULTS: In an intent-to-treat analysis, mean Hamilton Depression Scale scores dropped from 25.7 to 5.7 and from 25.8 to 5.0 in VitD and placebo groups, respectively (primary outcome; P = 0.92). VitD and placebo groups did not differ on other objective and subjective ratings of depression, or on global ratings. Similar findings characterized completer analyses. No significant correlations were observed between 25(OH)D levels and depression ratings across the course of the study. Importantly, endpoint escitalopram doses were 4 mg/day higher in placebo than in VitD patients, and 4 mg/day higher in VitD deficient than in VitD sufficient patients. LIMITATIONS: A ceiling effect with escitalopram may have prevented the discovery of benefits with VitD supplementation. CONCLUSIONS: VitD supplementation does not improve antidepressant outcomes with flexibly dosed escitalopram. VitD deficient depressed patients may require higher antidepressant doses to experience benefits similar to those whose deficiency is corrected by VitD supplementation.

Comparative Study of Sexual Side Effects in Female Patients With Schizophrenia Receiving Risperidone or Olanzapine.

Objective: To determine the prevalence of sexual dysfunction in female patients with schizophrenia receiving olanzapine or risperidone and to understand its relationship with other psychosocial variables.Methods: This cross-sectional descriptive study evaluated 57 female stabilized schizophrenia outpatients receiving risperidone (n = 28) or olanzapine (n = 29) in the psychiatric departments of a tertiary care hospital in South India from January to May 2019. Sexual dysfunction was assessed with the Changes in Sexual Functioning Questionnaire, severity of psychosis with the Brief Psychiatric Rating Scale, and level of improvement with the Clinical Global Impressions-Improvement and Severity scales.Results: Among the subjects, 93% of women receiving risperidone experienced sexual dysfunction compared to 83% in the olanzapine group. Sexual responses such as pleasure, frequency of sexual contacts, desire, arousal, and orgasm were significantly low in both drug groups (P < .05). Logistic regression of sexual dysfunction as dependent variable with other important variables found no significant relationship.Conclusions: This study suggests that sexual dysfunction is an important undetected problem in the majority of female schizophrenia patients. Risperidone was associated with more sexual dysfunction. Sexual dysfunction is an understudied yet important consideration in the treatment of schizophrenia.

A pilot, open-label investigation of the efficacy of glucosamine for the treatment of major depression.

INTRODUCTION: Glucosamine hydrochloride normalizes GABA antagonist- and social defeat-induced behavioral alterations and upregulation of immune response genes in Drosophila and mice, respectively, increases hippocampal neurogenesis in mice, and demonstrates efficacy in murine behavioral models of depression. This suggests that it may have antidepressant potential in humans. METHODS: In an open label, 4-week pilot study, patients (n = 20) diagnosed with mild to moderate, nonpsychotic (unipolar) major depressive episode (DSM-IV) were treated with glucosamine in monotherapy at 1 g/day for 1 week and 2 g/day for 3 more weeks. Patients were assessed at baseline, and at 2- and 4-week follow up using the 21-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impression-Improvement (CGI-I) scale, and other measures. An intent-to-treat analysis with last-observation-carried-forward was conducted on the whole sample. RESULTS: Three patients dropped out before the first follow up; the rest completed the study. HAM-D scores dropped by a third in the sample as a whole; however, only 4 patients (20 %) were considered HAM-D responders (improvement by >50 %) and only 2 patients (10 %) were CGI-I responders (endpoint score of 1 or 2). There were only 2 (10 %) HAM-D remitters (endpoint score <8). There were no serious adverse events and the treatment was well tolerated. CONCLUSIONS: Encouraging preclinical results notwithstanding, glucosamine monotherapy does not appear to be effective against major depression. A more authoritative conclusion would require a randomized controlled trial.

A case of Fregoli syndrome in schizophrenia.

Syndromes of delusional misidentification and reduplication are among the many neuropsychiatric conditions that affect both brain and behaviour and pose great challenges to mental health professionals. Fregoli syndrome belongs to the group of delusional misidentification syndromes with the belief that a familiar person is disguised as a strange person by taking different physical appearance but remains the same person psychologically. Though this he syndrome has been associated with organic cerebral dysfunction particularly of the right hemisphere, most cases occur in the setting of schizophrenia. Here we report a schizophrenic patient who developed Frégoli syndrome.

Life events, social support, coping strategies, and quality of life in attempted suicide: A case-control study.

BACKGROUND: Though deliberate self-harm encompasses a wide variety of medical and social disciplines some of the important psychosocial variable such as life events, social support, coping strategies, and quality of life have not yet been explored in depth in India. AIMS: The aim was to analyze and compare the type and severity of life events, coping strategies, social support, and quality of life of suicide attempters versus matched normal controls, and to identify the risk factors leading to suicide. MATERIALS AND METHODS: A total of 50 consecutive suicide attempters were compared with same number of age, sex, and martial status matched healthy controls using Presumptive Stressful Life Events Scale, Social Support Questionnaire, AECOM Coping Style Scale, and WHO QOL-Bref. RESULTS: Attempters experienced significantly more life events especially untoward events whereas the control group experienced more desirable and impersonal life events. Social support, positive coping, and of QOL were significantly lower in attempters. Among all risk factors desirable life events, good education, and good social support were protective against suicide. CONCLUSION: Suicide attempters were differentiated from healthy controls based on more stressful life events, lower social support, less healthy coping, and poor QOL. Positive life events, good education, and good social support were protective factors against suicide. However, it is difficult to pinpoint a single factor responsible for suicidal behavior. It is the complex interplay of various interrelated factors and the resultant buffering effect, which is protecting the individual against deliberate self-harm.

An exploratory analysis of personality factors contributed to suicide attempts.

BACKGROUND: People who attempt suicide have certain individual predispositions, part of which is contributed by personality traits. AIMS: The present study was conducted to identify the psycho-sociodemographic and personality related factors contributing to suicide attempts. MATERIALS AND METHODS: 104 suicide attempters admitted in various departments and referred to the department of psychiatry of IQRAA Hospital formed the study sample. They were evaluated with a self designed socio-demographic proforma, Eysenck's Personality Questionnaire Revised, Albert Einstein College of Medicine-Impulsivity Coping Scale, and Past Feelings and Acts of Violence Scale. STATISTICS ANALYSIS: The data was initially analyzed by percentage of frequencies. Association between socio-demographic and selected psychological factors was analyzed using t-test and Chi-square test. Intercorrelation among psychological factors was calculated by Pearson's correlation coefficient "r". RESULTS AND CONCLUSION: Factors such as young age, being married, nuclear family, feeling lonely and burden to family, inability to solve the problems of day to day life, and presence of psychiatric diagnosis and personality traits such as neuroticism, impulsivity, and violence were contributed to suicide attempt. A significant positive relationship between these factors was also identified. Findings of the present study call the attention of mental health professionals to identify these high risk factors in susceptible individuals and to modify these factors to prevent them from attempting suicide.

Plica neuropathica (polonica) in schizophrenia.

Plica neuropathica (Polonica) is a common but rarely reported scalp hair condition. In this condition the hairs of scalp in a localized area is compacted into irregularly twisted, irreversibly entangled plaits. Psychological disturbance is a risk factor for plica formation. We report a case of plica neuropathica in an adult female with schizophrenia.

Trichotillomania with trichorhizophagia in a schizophrenic patient: Case report and review of literature.

Trichotillomania is a disorder characterized by chronic hair pulling that often results in alopecia. Eating the part of hair pulled out is a common practice and trichorhizophagia is a new term to denote the habit of eating the root of hairs pulled out, associated with trichotillomania. Many psychiatric disorders are prevalent among patients with trichotillomania. Here we report a case of trichotillomania with trichorhizophagia in a 58-year-old man with schizophrenia. The various treatment options are also discussed.

Stevens - johnson syndrome induced by sodium valproate.

A case of Stevens-Johnson syndrome (SJS) following treatment with sodium valproate is presented. A 55-year-old male suffering from manic episode was treated with sodium valproate in addition to haloperidol and trihexiphenidyl. After two weeks he developed cutaneous manifestations of SJS. He was treated with systemic steroids, antihistamines and topical calamine lotion and recovered after a few weeks.