Objectives: Opioid dependence leads to reduced quality of life (QOL) and stigma. There is scarcity of literature on impact of buprenorphine on QOL of patients with opioid dependence from India. This study reports QOL and stigma in patients taking buprenorphine and compare it with those who were not on any treatment. Materials and Methods: A cross-sectional, descriptive, comparative study was conducted among three groups (n = 100 each). Group 3 comprised patients who were already taking buprenorphine for at least 3 months from a government outpatient opioid-assisted treatment center. Group 2 comprised patients who were not on any treatment but had come to enrol in buprenorphine treatment and Group 1 comprised patients who had come to get some other treatment and were not willing for buprenorphine. After fulfilling inclusion and exclusion criteria, sociodemographic pro forma, Hindi self-stigma scale, and World Health Organization QOL-BREF Hindi were applied. Appropriate statistical analyses were done. Results: Patients already taking buprenorphine had significantly better QOL and it improved as the duration of treatment increased. Patients on buprenorphine treatment had significantly lesser stigma than patients not already on treatment. Stigma negatively impacted QOL in the three groups. Conclusion: QOL and factors affecting it should be an integral part of management of opioid dependence. Efforts should be made to enrol maximum number of patients in treatment to enhance their quality of life and reduce stigma.
Involuntary movement disorders include tremors, tics, myoclonus, athetosis, chorea, dystonia, and dyskinesia. Neuroleptic drugs have the propensity to cause extrapyramidal side effects. Lithium-induced coarse tremors are well documented and may occur at therapeutic serum concentrations (0.8-1.0 mEq/L) in the treatment of bipolar disorder. Treatment for coarse tremors due to lithium includes either dose reduction or non-selective beta-blockers. To our knowledge, there are only four case reports regarding the lithium-induced awakening of cell memory of involuntary movement disorders worldwide. In scientific literature, only two drugs have the propensity to reawaken past cell memory. These intriguing findings can have a wider application across fields such as past-life regression therapy, post-traumatic stress disorder, catharsis, or recall of sub-aural temporal high-frequency burst-erased memory-type of mind-altering techniques. We report a case of lithium-induced awakening of the cell memory of involuntary dyskinesia in a female who took treatment for bipolar disorder in the past.
Background: No Indian studies have evaluated the impact of stigma, severity, and insight on the quality of life in obsessive compulsive disorder. Methods: A hospital-based, cross-sectional, descriptive study on 100 patients of obsessive-compulsive disorder (OCD) as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was conducted. Data were collected using socio-demographic performa, Yale-Brown obsessive-compulsive scale (Y-BOCS), WHOQoL-Bref hindi, hindi stigma scale, and Brown Assessment of Beliefs Scale (BABS) from March to June 2021. Appropriate statistical analyses were used. Results: A majority of patients were males (58%), married (65%), above matric pass (89%), and belonged to rural areas (62%). The total stigma score showed a significant negative correlation with overall QoL (P < 0.01**), overall health (P < 0.002**), satisfaction with physical health (P 0.006**), psychological health (P < 0.01**), and social relations (P < 0.01**) on WHOQoL-Bref. Discrimination, disclosure, and positive aspect domains of the stigma scale also showed a significant negative correlation with many domains of QoL. Severity of illness showed a significant negative correlation with overall QoL (P 0.045*), satisfaction with physical health (P < 0.01**), psychological health (P 0.01**), social relations (P 0.004**), and environment (P 0.007**). Poorer insight on BABS was associated with poorer overall health (P 0.04*), satisfaction with physical health (P 0.001**), social relations (P 0.03**), and environment (P 0.009**). Stigma was significantly increased by higher severity of obsessions (P 0.04*), compulsions (P 0.007**), and total Y-BOCS score (P 0.007**). Conclusion: Stigma and severity of OCD have a significant negative impact on quality of life. Stigma reduction and appropriate management of severity should be an integral part of management for patients with OCD.
Internet addiction has recently been suggested as a possible diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and incorporated in the International Classification of Diseases 11th Revision (ICD-11) as a gaming disorder, predominantly, online or offline. Mostly, psychotic phenomena have been described by either alcohol or opioid withdrawal, but there is a paucity of literature on Internet-related psychosis. We report two cases from Northern India of sudden onset of psychosis due to Internet addiction. The contents of hallucinations and delusions reflected themes of Internet gaming. Psychosis as a specifier for Internet gaming disorder (IGD) is not defined in DSM-5, whereas it should be considered as one of the presentations of Internet addiction.
Background: There is a widespread gap among medical professionals about transgender, and it needs to be addressed through proper educational intervention to inculcate positive attitudes toward transgender people. Aim: This study aimed to assess the attitude of medical undergraduate students toward transgender and change thereafter by educational intervention. Materials and Methods: A total of 169 final-year undergraduate students (aged 22-25 years; 50.3% males; all having heterosexual orientation) were assessed for their attitudes toward transgender people using the Genderism and Transphobia Scale (GTS) and Attitude toward Transgender Individuals Scale (ATTIS). Subsequently, an educational intervention was conducted. The attitude scores were again evaluated immediately and after one month of post-intervention. A paired t-test, independent-samples t-test, and analysis of variance (ANOVA) were used to compare the data. Results: Mean ATTIS and GTS scores before intervention were 67.02 ± 9.20 and 80.84 ± 26.07, respectively. After the educational intervention, these scores were 79.27 ± 7.18 and 63.20 ± 12.11, respectively, thus showing a significant change in both scores. The change in GTS score was significantly higher in males than in females (P < 0.001) and in urban than in rural residents (P = 0.017). No significant association of demographic factors was observed concerning the change in ATTIS scores. On evaluating the recall value, no significant decline in GTS or ATTIS scores was observed following a one month of interval. Conclusion: There is a need to positively reinforce these changes brought about by educational intervention in the attitude of undergraduate medical students toward transgender people. Such cognitive gains are achievable in developing a humanistic society.
Background: Diabetes mellitus is a chronic noncommunicable disease, and hypertension (HT) is the most common comorbidity which affects their quality of life (QoL). Aim: The aim of the study was to assess the effects of antihypertensive agents (viz., amlodipine, ramipril, telmisartan, and ramipril with telmisartan) on the blood pressure (BP) and QoL. Methodology: It was an open-labeled prospective intention-to-treat study done in diabetic hypertensive patients (CTRI/2016/10/007340). Patients were randomly assigned antihypertensive agents, namely, amlodipine, ramipril, telmisartan, and a combination of ramipril with telmisartan (RT) in four groups. They were evaluated for BP, blood sugar level, and QoL at baseline and 24th week. Results: After 24 weeks of therapy, systolic BP (SBP) and diastolic BP (DBP) were significantly reduced in all groups. In amlodipine, there was a mean percentage fall of SBP by 15.85% (confidence interval [CI]: 21.38-28.13) and DBP by 11.22% (CI: 8.41-12.70); in ramipril - 14.4% (CI: 18.61-25.15) and 12.4% (CI 8.88-13.99); telmisartan - 18.4% (CI: 24.89-10.79) and 14.6% (CI 10.79-16.24); and in RT group, SBP 17.7% (CI: 23.38-29.18) and DBP 12.4% (CI: 9.05-13.02). QoL score increased by 30.56% (CI: 14.30-10.90), 30.94% (CI: 14.21-10.68), 28.07% (CI: 14.89-11.20), and 28.84% (CI: 15.49-11.77), in respective groups (P < 0.0001, each). However, they were nonsignificant between the study groups (P > 0.05). Conclusion: Amlodipine, ramipril, telmisartan, and a combination of RT are equally effective to improve BP and QoL among diabetic hypertensive patients. However, amlodipine and telmisartan lacked in dry cough and more tolerable than the ramipril and RT therapy. Henceforth, amlodipine and telmisartan are better choice to control HT among DM patients.
Objective: Rhemercise is a novel mindfulness technique used to prevent relapse in opioid use disorder (OUD). Rhemercise is a quantifiable and intentional slow-breathing technique that could increase subjective well-being, which helps to prevent relapse in OUD by reducing craving, negative affect, and visceral reactivity. The objective of this study was to assess the efficacy of rhemercise as an adjunctive therapy in patients with OUD undergoing detoxification.Methods: This was a hospital-based, open-label, prospective, and exploratory study conducted between June 2018 and June 2019 that included 126 male inpatients admitted for detoxification of OUD. Patients with OUD diagnosed according to ICD-10 criteria who were aged 18-65 years were included in the study. Patients with other psychiatric disorders were excluded. Participants were divided into 2 groups: group A (n = 63) comprised patients receiving treatment as usual + rhemercise, and group B (n = 63) received treatment as usual only. Assessment tools included the Clinical Opiate Withdrawal Scale, Brief Pain Inventory, and Subjective Well-Being Inventory.Results: Various domains of the Subjective Well-Being Inventory (general well-being-positive affect [P = .02], confidence in coping [P = .007], inadequate mental mastery [P = .002]) improved significantly among OUD patients who received rhemercise treatment compared to treatment as usual.Conclusion: Rhemercise promoted general well-being and positive affect and decreased the opioid withdrawal symptoms, thereby potentially reducing the overall risk for relapse. Future studies are warranted with rhemercise to validate these promising findings.
Mindfulness , Opioid-Related Disorders , Substance Withdrawal Syndrome , Adolescent , Adult , Aged , Analgesics, Opioid/therapeutic use , Humans , Male , Middle Aged , Opioid-Related Disorders/drug therapy , Prospective Studies , Substance Withdrawal Syndrome/drug therapy , Young Adult
Today's fast paced life reports so much stress among people that it may lead to various psychological and physical illnesses. Yoga and meditation are the best strategies to reduce the effect of stress on physical and mental level without any side-effects. In this study, combined yoga and Sudarshan Kriya (SK) has been used as an alternative and complementary therapy for the management of stress. The aim of the study is to find a method to classify the meditator and non-meditator states with the best accuracy. The 50 subjects have been participating in this study and divided into two groups, i.e. study and control group. The subjects with regular practice of Yoga and SK are known as meditators and the ones without any practice of yoga and meditation were known as non-meditators. Electroencephalogram (EEG) signals were acquired from these both groups before and after 3 months. The statistical parameters were computed from these acquired EEG signals using Discrete Wavelet Transform (DWT). These extracted statistical parameters were given as input to the classifiers. The decision tree, discriminant analysis, logistic regression, Support Vector Machine (SVM), Weighted K- Nearest Neighbour (KNN) and ensemble classifiers were used for classification of meditator and non- meditator states from the acquired EEG signals. The results have demonstrated that the SVM method gives the highest classification accuracy as compared to other classifiers. The proposed method can be used as a diagnosis system in clinical practices.
Meditation , Yoga , Algorithms , Brain , Electroencephalography/methods , Humans , Machine Learning , Support Vector Machine , Wavelet Analysis
BACKGROUND: A high prevalence of psychiatric disorders, particularly depressive and anxiety disorders among women is observed through the postmenopausal stage. AIM: The aim of this study is to compare the safety and efficacy of tibolone (TIB) and escitalopram (ESCIT) in postmenopausal women (PMW). MATERIALS AND METHODS: It was an interventional, open-label, hospital-based, follow-up study conducted on 60 PMW with the diagnosis of depression as per the Diagnostic and Statistical Manual of Mental Disorder-5 criteria. Patients were divided into two groups of 30 each, i.e. Group I (TIB-2.5 mg/day) and Group II (ESCIT-10-20 mg/day). The primary outcome was assessed for change in climacteric symptom scores on Greene's Climacteric Scale (GCS), severity of depression and anxiety on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and sexual functioning on Arizona Sexual Experience Scale (ASEX). The secondary outcome of well-being was assessed on World Health Organization Quality of life (QOL)-BREF. All the observations were carried out from baseline and at 2, 4, 8, and 12 weeks. RESULTS: Both the groups showed significant improvement in climacteric and depressive symptoms. However, at the 8th and 12th weeks, mean ± standard deviation scores were significantly lower in Group I (GCS score - 24.80 ± 4.92, 20.30 ± 3.56; HAM-D score - 16.57 ± 5.83, 10.2 ± 5.67) compared to Group II (GCS score - 27.27 ± 5.83 and 23.33 ± 5.70, HAM-D score - 19.97 ± 7.98 and 16.17 ± 10.11). No significant difference between the groups was seen for anxiety on HAM-A scores. Only in Group I, there was significant improvement in ASEX scores. QoL in Group I had shown significant improvement in physical and psychological domain compared to Group II at different time interval, i.e. 4th and 8th week onward. In Group I, Alternative Dispute Resolution was reported to be 23.3%, whereas it was 56.7% in Group II. However, none were serious to warrant discontinuation. CONCLUSION: TIB was better than ESCIT in improving depression, climacteric symptoms, and physical and psychological domain of QoL with an additional benefit of restoring sexual functioning.
Nowadays, the style of living is restless and busy which has resulted in increased stress among many people. Stress causes various mental and health illness such as depression, anxiety, mood disorders, and aggressive behavior. Yoga and Sudarshan Kriya (SK) meditation are healthy ways to eradicate stress from people's lives. Based on the previous study, it has been analyzed that SK practice helps to enhance relaxation, management of emotion, alertness, focus, and antidepressant effect. In this paper, the combined impact of yoga and SK meditation has been analyzed on brain signals by using statistical parameters. To the best of the authors' knowledge, no such study has been conducted in the past. In this study, the pre and post Electroencephalogram (EEG) signals were captured from the control and study group before and after three months regular practice of combined yoga and SK. Discrete Wavelet Transform (DWT) has been used to decompose the signal into 6 sub-bands (0-4, 4-8, 8-16, 16-32, 32-64, 64-128) hertz (Hz) by using db4 wavelet for analysis, statistical features such as variance, standard deviation, kurtosis, zero crossing, maximum and minimum have been calculated from each sub-band. The obtained parameters have been validated by using Kruskal-Wallis statistical test. Further, Artificial Neural Network (ANN) has been applied on aforementioned statistical parameters to classify subjects as meditators and non-meditators. The experimental results indicated that the proposed method achieved 87.2% accuracy for classification and could be further extended to construct an accurate classification system for detection of meditators and non-meditators. This study forms a scientific foundation to encourage the use of meditation in clinical practices.
Brain/physiology , Meditation , Yoga , Adolescent , Adult , Electroencephalography/classification , Electroencephalography/statistics & numerical data , Humans , Male , Young Adult
BACKGROUND: The present study attempted to standardize insight in psychosis questionnaire in India and correlate insight with psychopathology and functioning. MATERIALS AND METHODS: A cross-sectional study was conducted in July and August 2016. The questionnaire was translated into Hindi following standard procedure. After ensuring that the patients fulfilled criteria for the study, consent was taken, and insight in psychosis questionnaire (Hindi version), positive and negative syndrome scale for schizophrenia, clinical insight rating scale, Present State Examination insight item, and the global assessment of functioning scale were applied. Appropriate statistical analyses were done. RESULTS: The mean age of 53 patients included in the study was 33.42 ± 10.32 years. The majority of the patients were males, single and had <12 years of formal education and resided in joint families and urban areas. The mean duration of illness was 78.64 ± 86.16 months. The insight in psychosis questionnaire was found to have good internal consistency, split-half reliability, test-retest reliability, and convergent validity in the Indian population. Patients residing in the rural background had lower insight than those residing in urban areas, and patients having brief psychotic disorder had lower insight than those having schizophrenia. Insight was positively correlated with negative symptoms, general psychopathology, and total psychopathology but negatively correlated with positive symptoms. Psychopathology was negatively correlated with functioning. CONCLUSIONS: The study of insight and its correlation with psychopathology and functioning should be an important area for research as insight is associated with outcome and prognosis among patients with psychosis.
AIMS: To assess the prevalence of epilepsy in a rural area adjoining a city. METHODS: A door-to-door, cross-sectional epidemiological survey was carried out covering an entire rural population of 103,693 people. RESULTS: Crude period and point prevalence rates for active epilepsy were 7.67 and 7.44 per 1,000 respectively. Crude incidence rate was 60.76 per 100,000 during the year 2007. Mean, SD, median and variance were 17.2, 16, 13 and 257.6 years respectively for age at onset of active epilepsy patients. The overall prevalence patterns among males and females were not significantly different. Active epilepsy cases (n = 795) included electro-clinical syndromes and constellations (n = 117, 14.7%), symptomatic epilepsy (n = 153, 19.2%), epilepsy due to unknown cause (n = 513, 64.5%) and dual diagnosis (n = 12, 1.5%). CONCLUSIONS: The present study showed that the prevalence rate, in the rural area adjoining a city, was comparable to that of the urban area and significantly less than that of the remote rural area as described by another study. Age- and sex-specific prevalence and incidence rates were similar to the rates reported by other studies. The reason for a lower number of symptomatic cases to be reported, per this study, may be due to lack of neuroimaging.
Epilepsy/epidemiology , Adolescent , Adult , Age Distribution , Age of Onset , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Female , Health Surveys , Humans , Incidence , India/epidemiology , Infant , Infant, Newborn , Male , Middle Aged , Prevalence , Rural Population , Sex Distribution , Young Adult
We report a case of Tourette's disease (TD) with impulse control disorder which is rare;these type of patients are prone to rage attack and explosive outbursts in the childhood and adolescence which can be detrimental. Hence, a case is reported to understand the phenomenology of its co-morbidity in TD.
The authors report a family from Punjab (India) with 10 members having benign familial neonatal convulsions (also known as benign familial neonatal seizures) in two generations. This disorder is quite rare. The clinical presentation of index case along with the findings of computed tomography of the brain and electroencephalograph is described. Important features of all the family members along with a brief review of the literature are also given.
Amisulpride, a substituted benzamide derivative, is a second-generation antipsychotic that preferentially binds to D2/D3 receptors in limbic rather than striatal structures. High dosage preferentially antagonizes postsynaptic receptors, resulting in reduced dopamine transmission; and low dosage blocks presynaptic receptors, resulting in enhanced transmission. Hyperprolactinaemia may occur in patients receiving amisulpride at low dose of 50 mg/day and results in galactorrhoea, amenorrhea and sexual dysfunction. The symptom ameliorates on withdrawing the drug, switching to non-prolactin-elevating drugs, and timely management with dopamine agonist.
A case is reported where the patient developed angioneurotic oedema of the lip after the use of tadalafil.1 On withdrawal of tadalafil, complete remission was obtained through required symptomatic treatment. Clinicians should be aware of the possibility of development of angioneurotic oedema in patients undergoing treatment with tadalafil.
