Review of Psychotropic Agents Associated with Sialorrhoea, Except Clozapine.

Introduction: Sialorrhoea, or excessive salivation, is common in psychiatric patients. This can be distressing because of its physical and psychosocial complications. Sialorrhoea due to psychotropic drugs has been reported repeatedly in the literature. Clozapine is the antipsychotic most commonly associated with sialorrhoea. Objective: The objective of this review was to examine and discuss the existing literature on all psychotropic drugs associated with sialorrhoea, except clozapine. Methods: Google Scholar and PubMed were searched for the literature on psychotropic-induced sialorrhoea. The search terms used were sialorrhoea, antidepressants, antipsychotics, mood stabilizer, and benzodiazepines. Case reports on patients suffering from psychotropic-induced sialorrhoea except clozapine are reviewed in this study. Results: The pathophysiology behind psychotropic-induced sialorrhoea, the population susceptible to sialorrhoea, and the exact duration from the start of sialorrhoea the drug course to the onset of sialorrhoea are unknown. Also, sialorrhoea is not associated with drug toxicity and is observed even in patients receiving normal doses of psychotropic medications. Treatment involves dose reduction, discontinuation of drugs responsible for the adverse effect, or adding anticholinergic drugs. Conclusion: Sialorrhoea due to clozapine has been reported in the literature. Many other antipsychotics, antidepressants such as sertraline, and other psychotropic drugs such as lithium have also been reported to cause sialorrhoea. No increase in the risk of sialorrhoea was seen in any of the age groups, and no association was found with treatment duration. In cases of lithium-induced sialorrhoea, no relationship was observed between serum levels of lithium and sialorrhoea.

A qualitative analysis of literature reporting and linking psychosis to COVID-19 infection. Findings from a postgraduate journal club.

Acute exacerbations of psychosis have been reported with COVID-19 infection and medications used for its treatment. Terms "psychosis", "psychotic", "COVID-19″ and "coronavirus" were searched on "PubMed" and "GOOGLE SCHOLAR", yielding 84 articles. 14 case reports were selected based on pre-defined criteria and analyzed. Among selected articles,10 attributed psychosis to COVID-19 infection. In 3 articles, psychosis was diagnosed despite concurrent delirium. In 8 and 3 articles respectively, a clear temporal demarcation of psychosis and COVID-19 infection and steroid use was not described. Psychosis can occur secondary to GMC, or exposure to medication. Due process should be followed to ascertain the same. INTRODUCTION: Neurotropic coronavirus infection is associated with numerous neurological and neuropsychiatric manifestations. Such presentations before, during and after the infection have been reported. Among these presentations, acute exacerbations of psychosis have been reportedly linked with COVID-19 infection and medications used for its treatment. METHODOLOGY: Search engines "PubMed" AND "GOOGLE SCHOLAR" were searched using specific search terms during June 2021. Out of 84 articles that came up, we selected 14 articles based on pre-determined inclusion and exclusion criteria. Selected articles were analysed and discussed in the departmental journal club. RESULTS: In 10 articles, diagnosis of psychosis was attributed to COVID-19 infection. In 3 of those articles, despite reporting concurrent delirium like presentation, diagnosis was still reported as psychosis. In 8 articles, the temporal correlation between onset of psychosis, onset of COVID-19 was not clearly demarcated. In 3 articles, clear demarcation between psychosis associated with steroid use and with a general medical condition (COVID-19) was not clearly presented. Only 2 articles did mention using a structured diagnostic system. In patients (3/17) with prior history of psychiatric illness, diagnosis was reported as relapse of psychosis (2/17), without specifying the criteria used for diagnosing a relapse. CONCLUSION: Acute exacerbation of psychosis can occur secondary to a general medical condition (GMC), or after exposure to a medication. However, due process should be followed to ascertain that the psychosis is indeed secondary to a GMC, or a medication, and not a de-novo presentation, or delirium.

Efficacy of a suicide sensitisation and prevention (SSP) workshop for medical students on their attitudes, beliefs, and factual knowledge on suicide: A pilot study.

Context: Myths and stigma about suicide and mental health among doctors are widely prevalent in India. Didactic methods of teaching alone may not be adequate to bridge the knowledge gap. Methods: Fifty-seven MBBS students participated voluntarily by accepting an invitation. They were examined pre-intervention with the Suicide Opinion Questionnaire (SOQ) for their attitudes and beliefs about suicide. Students then underwent a custom-made extracurricular Suicide Sensitization and Prevention workshop. It consisted of a 120-min session that included a didactic session on the bio-psycho-social model of suicide and two role-plays demonstrating Suicide Prevention Early Intervention Communication (SPEIC). Students were examined again after seven days with SOQ, and with the SPEIC checklist. Results: Fifty students completed the study protocol. There was a 9.5% increase in SOQ scores post-intervention indicating a change toward positive attitudes/beliefs about suicide. The emotional perturbation subscale showed the highest degree of improvement, whereas the acceptability subscale showed the least improvement. Students were able to recall 40% and 60% from the Do-Checklist and the Do Not Checklist from the SPEIC after seven days from the workshop. There was no difference in SOQ performances pre- and post-intervention in students who knew someone with psychiatric illness, or with a history of an attempt or death by suicide. Conclusion: Using role-plays and interactive teaching methods can be effective in teaching psychiatry and mental health issues to medical students. The results indicate not only better understanding of subject matter but also recall after a week from the intervention.

A Study of Magnitude and Psychological Correlates of Smartphone Use in Medical Students: A Pilot Study with A Novel Telemetric Approach.

CONTEXT: Smartphone use is being investigated as a potential behavioral addiction. Most of the studies opt for a subjective questionnaire-based method. This study evaluates the psychological correlates of excessive smartphone use. It uses a telemetric approach to quantitatively and objectively measure participants' smartphone use. METHODOLOGY: One hundred forty consenting undergraduate and postgraduate students using an Android smartphone at a tertiary care teaching hospital were recruited by serial sampling. They were pre-tested with the Smartphone Addiction Scale-Short Version, Big five inventory, Levenson's Locus of Control Scale, Ego Resiliency Scale, Perceived Stress Scale, and Materialism Values Scale. Participants' smartphones were installed with tracker apps, which kept track of total smartphone usage and time spent on individual apps, number of lock-unlock cycles, and total screen time. Data from tracker apps were recorded after 7 days. RESULTS: About 36 % of participants fulfilled smartphone addiction criteria. Smartphone Addiction Scale score significantly predicted time spent on a smartphone in the 7-day period (ß = 0.234, t = 2.086, P = 0.039). Predictors for time spent on social networking sites were ego resiliency (ß = 0.256, t = 2.278, P = 0.008), conscientiousness (ß = -0.220, t = -2.307, P = 0.023), neuroticism (ß = -0.196, t = -2.037, P = 0.044), and openness (ß = -0.225, t = -2.349, P = 0.020). Time spent gaming was predicted by success domain of materialism (ß =0.265, t = 2.723, P = 0.007) and shopping by ego resiliency and happiness domain of materialism. CONCLUSIONS: Telemetric approach is a sound, objective method for evaluating smartphone use. Psychological factors predict overall smartphone usage as well as usage of individual apps. Smartphone Addiction Scale scores correlate with and predict overall smartphone usage.

Electronic journal clubs for capacity building: A case study in psychiatry as a model for medical disciplines in developing countries.

BACKGROUND: Journal clubs (JCs) teach participants how to critically read and assimilate materials published in journals. Electronic JCs (eJCs) provide a similar platform through internet groups, allowing members to participate in and review JC activities as well as JC archives in their free time. METHODS: We describe the operations and the successes of eJCIndia, to our knowledge the first eJC in India in the field of mental health. eJCIndia was started for capacity building in teaching and research competence in the field. RESULTS: eJC India, with >400 members comprising academic psychiatrists and postgraduate students, is now 3 years old. eJCIndia conducts about a hundred activities a year; there is active participation from the membership. Activities include posting of educational materials of interest to the group; seeking and receiving guidance on academic and practical matters of interest to the group; providing and receiving training on how to review research manuscripts submitted to journals for consideration for publication; learning how to critically review published journal articles for strengths, limitations, and applications; and learning how to design studies, analyze data, and prepare manuscripts for publication. The activities of eJCIndia have resulted in the publication of about 20 articles and in the development of several research collaborations, including one multicenter study. CONCLUSIONS: The eJCIndia model can be replicated across medical disciplines in India and elsewhere. It may be the most efficient means for manpower development and capacity building in academic and research competence, given the inequitable geographical distribution of academic expertise in developing countries.

A Study of Patterns of Platelet Counts in Alcohol Withdrawal.

AIMS: This study aimed to evaluate the patterns of platelet counts during the course of alcohol withdrawal and its relationship if any with liver enzymes. METHODOLOGY: Forty consecutive patients, with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders-fourth edition, Text Revision criteria, willing for a 10-day inpatient detoxification program and presenting within 12 h of the last consumption of alcohol were recruited in the study. Details about the diagnosis and alcohol consumption patterns were assessed with a detailed psychiatric interview. After admission, routine investigations (complete blood counts [CBCs] and liver function tests) were sent and records were kept. CBC was sent for platelet counts on the 2nd, 4th, 6th, 8th, and the 10th day of alcohol withdrawal. RESULTS: Nearly 40% of the patients developed delirium tremens (DT group) and rest had an uncomplicated alcohol withdrawal (ND group). Platelet counts at baseline and all the 4 days of collection were significantly lower in DT group than the ND group. Platelet counts increased gradually from baseline till 10th day of alcohol withdrawal, mean increase in platelet counts being 88.61 ± 11.60% (median: 61.11%, range [23.41-391.23%]). Platelet counts in 63% of the patients showed a drop on the 4th day of withdrawal before rising till the 10th day of alcohol withdrawal. Platelet counts were not affected by liver enzymes or other alcohol consumption patterns. CONCLUSIONS: Transient thrombocytopenia and reverse thrombocytosis during alcohol withdrawal are associated with an initial drop in platelet counts. The synchrony between the drop and the onset of DT needs to be evaluated.

Insomnia, dreams, and suicide: Connecting links.

INTRODUCTION: A growing empirical literature has examined insomnia symptoms as a possible risk factor for a range of suicidal behavior. Not much literature is available in normal adolescent population. AIMS: The aim is to find insomnia prevalence, studying various dream factors, and suicidality prevalence among students of various courses. To check if there is a relation between insomnia and suicidal behavior and dreams, particularly nightmares and suicide. MATERIALS AND METHODS: A total of 400 students of various courses were assessed using Insomnia Severity Index and The Mannheim Dream Questionnaire and Suicide Behaviour Questionnaire. RESULTS: Insomnia was present in 11%, 23%, 19%, and 19% and suicide behavior in 16%, 17%, 12%, and 22%, respectively, in medical, commerce, engineering, and arts students. Statistically significant correlation was found between suicide and insomnia severity and various dream factors. CONCLUSIONS: Insomnia and dreams had relation with suicidality in normal adolescent population.

Abdominal Epilepsy in an Adult: A Diagnosis Often Missed.

Abdominal Epilepsy (AE) is a variant of temporal lobe epilepsy and is commonly seen in pediatric age group. There are however, multiple reports of abdominal epilepsy in adolescents and even in adults. Chronic and recurrent gastrointestinal symptoms with one or more neuropsychiatric manifestations are often the presenting picture for a patient with AE. Such patients therefore, are more likely to consult a general practioner, a physician, a surgeon or a gastroenterologist than consulting a psychiatrist or a neurologist. We hereby present such a case of AE in an adult with review of similar reports.

Celebrity suicide and its effect on further media reporting and portrayal of suicide: An exploratory study.

BACKGROUND: Suicide is a grave mental health problem in India, and suicide rates in India have risen over the past decades. Suicide reporting by the media is a common cause for spurts of suicides that may occur from time to time. The aim of the present study was to assess the change in trends in media reporting of suicide after a celebrity suicide. METHODOLOGY: Suicide by the renowned actor Robin Williams was selected as the reference case. The top three Indian daily newspapers published in English having the highest circulation as per the Registrar of Newspapers, Government of India report were selected to be scanned in the study. These were the Times of India - Mumbai edition, Mumbai Mirror, and the Daily News Analysis - Mumbai edition. The authors screened all news stories in the three newspapers within a 6-month period (3 months prior and 3 months post the date of the reference suicide case), and these news reports were evaluated as per the suicide reporting guidelines for media laid down by the Indian Psychiatric Society. The data were analyzed using Chi-square test and descriptive statistics where appropriate. RESULTS: A total of 708 newspaper articles were identified on the basis of the guidelines mentioned above. Nearly 88% (n = 623) of the articles directly covered suicide while 4.09% (n = 29) focused on suicidal threats and 7.91% (n = 56) focused on parasuicide behavior. There was a significantly greater increase in the total number of articles printed after the celebrity suicide (n = 409) for all article types except teasers as compared to that before the celebrity suicide (n = 299). There was a significantly greater increase in front page news on suicide after the celebrity suicide (P = 0.0016), description of the method of suicide (P = 0.0221), and the mention of the suicide notes (P = 0.0002). Most articles after the celebrity suicide placed the blame on someone or the environment for the act (P = 0.0001). CONCLUSIONS: A change in media trend toward reporting suicide was noted post a celebrity suicide, and it is important that media follow guidelines stringently when reporting a serious problem like suicide.