Pharmacogenomics-assisted schizophrenia management: A hybrid type 2 effectiveness-implementation study protocol to compare the clinical utility, cost-effectiveness, and barriers.

OBJECTIVES: The response to antipsychotic therapy is highly variable. Pharmacogenomic (PGx) factors play a major role in deciding the effectiveness and safety of antipsychotic drugs. A hybrid type 2 effectiveness-implementation research will be conducted to evaluate the clinical utility (safety and efficacy), cost-effectiveness, and facilitators and barriers in implementing PGx-assisted management compared to standard of care in patients with schizophrenia attending a tertiary care hospital in eastern India. METHODS: In part 1, a randomized controlled trial will be conducted. Adult patients with schizophrenia will be randomized (2: 1) to receive PGx-assisted treatment (drug and regimen selection depending on the results of single-nucleotide polymorphisms in genes DRD2, HTR1A, HTR2C, ABCB1, CYP2D6, CYP3A5, and CYP1A2) or the standard of care. Serum drug levels will be measured. The patients will be followed up for 12 weeks. The primary endpoint is the difference in the Udvalg for Kliniske Undersøgelser Side-Effect Rating Scale score between the two arms. In part 2, the cost-effectiveness of PGx-assisted treatment will be evaluated. In part 3, the facilitators and barriers to implementing PGx-assisted treatment for schizophrenia will be explored using a qualitative design. EXPECTED OUTCOME: The study findings will help in understanding whether PGx-assisted management has a clinical utility, whether it is cost-effective, and what are the facilitators and barriers to implementing it in the management of schizophrenia. TRIAL REGISTRATION: The study has been registered with the Clinical Trials Registry-India (CTRI/2023/08/056210).

Colossal Breed and Backlash of the 'Sesame Street': Brunt of COVID-19 Pandemic in the 'High-Tech' Era of Learning on Children and Adolescents and Suggestions.

The COVID-19 pandemic necessitated the closure of various academic institutions, leaving online learning the only option for continuity of education and curricular activities among children and adolescents. It is unclear whether the adoption of online learning will persist in the post-pandemic period. However, enhanced exposure to gadgets impacts the socio-emotive-adaptive development of young children. It sprouts various short-term as well as long-term deleterious physical and mental health effects among children and adolescents. Research has focused mainly on the epidemiology, risks modeling, pathophysiology, and clinical features of SARS-CoV-2, but the impact of increased exposure to gadgets and technology due to online learning activity and the "digital new-norm" has largely been unnoticed. The enforced/self-quarantine leading to less outdoor activities during this pandemic, may have a cumulative poor health consequence. Early detection and management of those at risk and signs and symptoms of these adverse health effects are important. Awareness regarding these ill-effects on this vulnerable group is relevant for parents, guardians, teachers, mentors, health-care providers, and policy-makers.

One Flew over the Cuckoo's Nest: The Chronicles of Stigma and a Proposed Socio-Cognitive-Emotional-Behavioral Model for Understanding Its Genesis in COVID-19.

Stigma is a convoluted interaction between history, sociology, psychology, medicine, anthropology, and politics. Often, stigma is inter-twined at cognitive-emotional-behavioral level with a socio-cultural-economic-political milieu and hence distinct from prejudice, discrimination or, stereotypy. Stigma against diseases as a concept has evolved and has differed among various illnesses. At this time of humanitarian crisis, it is prudent to understand the concept, elements and models of stigma to tackle stigma against COVID-19 instrumentally. Stigma against COVID-19 can be partially extrapolated from various models described in psychiatry for mental illness. We propose an integrated socio-cognitive-emotional-behavioral model of stigma to conceptualize and understand the stigma against COVID-19, a matter of immense public health significance.

The Telepsychiatry Operational Guidelines 2020 in India: a welcome step.

The release of the Telepsychiatry Operational Guidelines 2020 in India, during the COVID-19 pandemic, is a relief for both clinicians and patients. These guidelines embark on initiating and executing naive and recently started telepsychiatry services in India. The document is aligned with other ethical regulations, policies, laws and the 2020 Telemedicine Practice Guidelines in India. This paper discusses a few points about the broader applicability of the guideline for the benefit of humankind in the prevailing healthcare crisis. The guidelines may be extrapolated in policy-making for telepsychiatry services in other low- and middle-income countries sharing a similar socioeconomic, cultural and political milieu.

COVID-19 and suicides in India: A pilot study of reports in the media and scientific literature.

BACKGROUND: Our objective was to analyze reports of COVID-19 related suicides (CRS) to identify associated factors with a broader goal to inform management and prevention strategies. METHODS: We searched scientific literature, government websites and online newspaper reports in English and nine regional languages to identify relevant CRS reports. RESULTS: A total of 151 CRS reports were retrieved. CRS was more frequently reported among males (80.8%), those whose COVID status was unknown (48.0%), and those in quarantine/isolation (49.0%). CONCLUSION: The above findings may assist identification of at-risk individuals for COVID-19 related suicidal behavior.

Caregiver Burden in the Patients of Acute Myeloblastic Leukemia.

To study the caregiver burden and its correlates among the caregivers of adolescent and adult subjects with acute myeloblastic leukemia (AML). 30 caregivers of patients with AML were evaluated on family burden interview schedule (FBI), Caregiver Strain Index, multi-dimensional aspect of perceived social support scale, Cognitive-Behavioural Avoidance Scale, ways of coping checklist and General Health Questionnaire. Caregivers of patients with AML reported high caregiver burden (FBI objective burden score: 27.8; subjective burden score: 1.43). Among the various domains of FBI, the mean scores were highest for the domain of disruption of family activities and this was closely followed by disruption of family leisure. Patients with lower family income reported higher subjective and objective burden and were more overwhelmed. Patients belonging to lower socioeconomic status reported more financial burden. Caregiver burden was higher among caregivers who reported lower perceived social support, who more often used avoidance and escape as coping and less often used acceptability-responsibility and positive appraisal coping. Higher caregiver burden is associated with higher psychological morbidity. Caregivers of subjects with AML experience high level of caregiver burden and it is associated with lower social support and more often use maladaptive coping strategies.

Correlates of Positive Aspects of Caregiving Among Family Caregivers of Patients with Acute Myeloblastic Leukaemia.

To evaluate the positive aspects of caregiving and its sociodemographic and clinical correlates in family caregivers of patients with Acute Myeloblastic Leukaemia (AML). A total of 30 caregivers of the patients with AML were evaluated on the Scale for Positive Aspects of Caregiving Experience (SPACE), Family Burden Interview (FBI) and Schedule and Caregiver Strain Index (CSI). On the SPACE, the mean score was highest for the domain of motivation for the caregiving role, followed by the domain of 'caregiving personal gains', 'caregiver satisfaction' and least score was seen in the domain of 'self-esteem and social aspect of caring'. All the SPACE domains were negatively correlated with financial burden, disruption of routine family activities, disruption of family interaction, physical health and subjective burden domains of FBI. Effect on physical health of others domain of FBI correlated negatively with all domains of SPACE except 'self esteem and social aspect of caregiving'. FBI total objective burden was negatively correlated with motivation for caregiving role, caregiver satisfaction and total SPACE score. All SPACE domains were negatively correlated with adaptation and inconvenience domains and total CSI score. Lower level of positive caregiving experience is reported by caregivers who experience high level of caregiver burden.

Geochemical modeling of high fluoride concentration in groundwater of Pokhran area of Rajasthan, India.

The groundwater is the only major source of drinking water in western part of Rajasthan, India. The study was carried out to locate and decipher hydrogeochemical reactions responsible for elevated concentration of fluoride. The concentration of fluoride ranged from 0.6 to 4.74 ppm in groundwater of study area. Since the area is a desertic terrain and no industries are present thus possibility of anthropogenic input of fluoride is all most negligible thus the enrichment of fluoride in groundwater is only possible due to rock-water interaction. The highly alkaline conditions indicated fluorite dissolution as major process responsible for high concentration of fluoride in Pokhran.