Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease.

Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score<3, received pulmonary rehabilitation (PR) and standard medical management]; ii and iii) group B and C (GHQ-12 score>3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p<0.001). mMRC score, SGRQ score, FEV1 and 6-MWD significantly improved in all three groups. Improvement in mMRC and SGRQ was maximal in group B when compared with the other groups. PDT, CSCL, and WHO-QOL-Bref-26 scores improved significantly at follow-up in all three groups, with maximum improvement in group B, followed by group C, and then group A. The DASS score also improved maximally in group B. Patients should be screened for psychological co-morbidities using simple screening tools. PR plays an important role in improving the psychology of COPD patients. However, results are better with directed psycho-educative sessions by non-experts and best with definitive treatment by psychiatrists.

Comparative effectiveness of aripiprazole and olanzapine on neurocognitive profile of patients with schizophrenia.

Background: Schizophrenia causes significant neurocognitive impairment. Treatment with antipsychotics leads to improvement in psychopathology and neurocognitive functions. Aim: To see comparative effectiveness of aripiprazole and olanzapine on neurocognitive profile of patients with schizophrenia. Materials and Methods: This was a comparative, prospective, and interventional study. Patients with schizophrenia as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), were assessed on Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), and neuropsychological tests at baseline. Patients were randomly assigned to aripiprazole (10-30 mg per day, orally) and olanzapine (5-20 mg per day, orally) groups on the basis of computer-generated random table number. Patients were reassessed at 10 weeks. Results: A total of 40 patients completed the study duration of 10 weeks. At baseline, the majority of patients showed significant impairment in one or more domains of neurocognition. Both aripiprazole and olanzapine led to improvement in psychiatric symptoms as well as neurocognitive profile. Aripiprazole treatment leads to significant improvement in mental speed as compared to olanzapine. A highly significant decrease in the value of the Stroop effect indicates improvement (P = 0.000**) with aripiprazole and visual-spatial constructive ability (P < 0.001). The olanzapine group showed highly significant improvement in performance of category fluency (P < 0.01) and verbal fluency (P < 0.01). Conclusion: The study concludes that aripiprazole and olanzapine have strong potential to improve specific domains of neurocognitive profile.

Role of Meditation in Ameliorating Examination Stress Induced Changes in Cardiovascular and Autonomic Functions.

Background: Examination stress is a very well-known model of psychological stress in students. It induces changes in systolic (SBP) and diastolic blood pressure (DBP), along with changes in heart rate variability (HRV) and baroreflex sensitivity (BRS), due to autonomic perturbations. Purpose: To find out if Raj Yoga meditation (RYM) practice affects autonomic and cardiovascular function in healthy young subjects during periods of examination stress. Our primary objective was to evaluate the effect of one month of supervised RYM practice on ameliorating examination-induced changes in cardiovascular and autonomic function. The secondary objective was to measure the stress levels of medical students before and after RYM. Methods: Pre-training measurements of SBP, DBP, HRV, and BRS were done, and the Medical Student Stressor Questionnaire (MSSQ) was administered to 80 participants one month before examinations. They were then trained in RYM. Post-training assessment of the same parameters was done after examinations and also after two months. Results: In our study, RYM training decreased DBP (p = 0.01) but not SBP. BRS showed a trend towards an increase after RYM practice, but it was not statistically significant (p = 0.44). The standard deviation of the NN interval (SDNN) (p = 0.03), low-frequency (LF) nu (0.003), and high-frequency (HF) nu (0.04) showed a statistically significant change. Average RR, median RR, average rate, square root of the mean squared differences of successive NN intervals (RMSSD), pRR, total power, LF (µs2), and LF/HF ratio were not statistically significantly different between the three groups. There was a statistically significant decline in MSSQ scores for MSSQ I (p = 0.04), MSSQ II (p = 0.04), and MSSQ IV (p = 0.03). Conclusion: Short-term practice of supervised RYM during stressful periods is protective for the cardiovascular and autonomic systems and decreases stress in medical students.

Effects of Abstinence From Opioid on Neuropsychological Performance in Men With Opioid Use Disorder: A Longitudinal Study.

OBJECTIVES: Impairments in neuropsychological functioning (mainly memory, learning, attention, and executive functioning) among persons with long-term opioid use disorder (OUD) have been widely reported, with few studies suggesting that these are not permanent and can improve with abstinence. Thus, present study aimed to evaluate the neuropsychological functioning in persons with OUD and examine the effects of abstinence on the same over a period 8 weeks. METHODS: A total of 50 patients with diagnosis of OUD as per the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition ( DSM-5 ) criteria underwent serial longitudinal neuropsychological assessments for executive functioning, attention and concentration, and verbal and nonverbal memory at baseline, 2 weeks, and 8 weeks of abstinence. RESULTS: The mean performance scores representative of attention, concentration, verbal memory, and nonverbal memory showed significant improvement in the initial 2 weeks, and executive functioning showed significant improvement by 8 weeks of abstinence (all P 's < 0.01). A significant negative correlation was found between the duration of opioid use and performance on verbal memory tests (0.014), the frequency of intake per day and performance on nonverbal memory and executive functioning tests, and the severity of opioid dependence and performance on nonverbal memory test (0.019). CONCLUSIONS: Neuropsychological functioning in certain domains was associated with the duration of opioid use, the frequency of daily opioid intake, and the severity of opioid dependence among persons with OUD at baseline. It showed significant improvement in domains of attention, concentration, verbal and nonverbal memory, and executive functions over a period of 8 weeks of abstinence.

Oral versus long-acting injectable antipsychotic in first episode schizophrenia: A 12 weeks interventional study.

Background: There is underutilization of long-acting injectable (LAI) antipsychotics for first-episode schizophrenia (FES) despite having convenient dosing and treatment retention. LAIs are predominantly used for patients with poor compliance, chronic course, and multiple relapses. Materials and Methods: Seventy-two treatment naïve patients with the first episode of Schizophrenia (DSM-5) were assessed for baseline severity of psychopathology using the positive and negative syndrome scale (PANSS) and quality of life (QOL) using the WHOQOL-BREF scale. Patients were randomized to receive either oral haloperidol or LAI haloperidol for a period of 12 weeks. Results: Both the groups had a significant reduction in PANSS scores and improvement in QoL over 12 weeks period (P = 0.0001). The LAI group showed greater adherence and significantly better quality of life than the oral group (P = 0.023). The mean numbers of side effects were less in the LAI group at week 2 as compared to the oral group. Conclusion: LAI haloperidol is similar to oral haloperidol in patients with FES with respect to treatment response and offers benefits in form of a lesser number of side effects during early treatment, overall better adherence rates, and better QOL.

Telomerase enzyme activity in patients with major depressive disorder: A pre and post-treatment study.

BACKGROUND: Telomerase is a cellular enzyme that prevents telomere shortening and promoting viability. The literature has reported shortened telomere length in patients with major depressive disorder (MDD). METHODS: 35 patients with diagnosis of major depressive disorder (MDD) fulfilling DMS-5 criteria in the age range of 18-60 years, treatment-naïve after assessing the severity on HAM-D and HAM-A and 35 age and sex matched healthy controls were included in the study. Baseline peripheral blood monocytes (PBMC) telomerase enzyme was assessed in cases and controls and repeated in cases of MDD at 8th week after intervention with escitalopram for 8 weeks. RESULTS: Pretreatment telomerase activity (TA) was elevated in cases as compared to controls and it was also significantly correlated to the severity of depression (p = 0.00). There was a significant positive difference in telomerase activity between non-responders (higher TA) and responders at baseline (p = 0.001) and 8th week (p = 0.012). The TA did not vary significantly amidst pretreatment and post-treatment, although it was slightly lower in the post-treatment group. LIMITATIONS: The study has few limitations in the form of small sample size, shorter duration of follow-up, and leucocyte telomeres length (LTL) was not assessed. CONCLUSION: The index study concludes that TA is higher in drug naïve patients with MDD than age and sex matched healthy control. The non-responders had significantly higher TA as compared to responders at baseline and post-treatment which indicates TA as a potential biomarker in the underlying biological mechanism of MDD and in response to antidepressant pharmacotherapy.

Effect of sertraline and fluvoxamine on quality of life in patients with obsessive-compulsive disorder: A 12-week interventional study.

Background: Obsessive-compulsive disorder (OCD) is associated with poor quality of life (QoL) and functionality. Treatment leads to improvement in QoL and better functioning. Aim: To assess the effect of treatment with SSRIs on QoL and disability in first-episode, drug-naïve patients with OCD. Materials and Methods: Fifty first-episode, drug-naïve patients with a diagnosis of OCD according to the Diagnostic and Statistical Manual 5 were assessed for severity of illness (Y-BOCS), World Health Organization QoL (WHO-QoL Bref), and disability (WHODAS 2.0) at baseline and at 12 weeks after receiving treatment with either sertraline or fluvoxamine. Results: The scores for QoL were low and for disability were high at baseline, and the scores for WHO-QoL-Bref and WHODAS 2.0 improved significantly after 12 weeks of treatment compared to baseline. This improvement correlated with reduction in the illness severity scores on Yale-Brown Obsessive-Compulsive Scale. The responders to treatment had better QoL and lower disability compared to nonresponders. Conclusion: There is an impairment in QoL and disability in first-episode, drug-naïve patients with OCD, and QoL improves and disability decreases with adequate treatment with SSRIs, and this improvement correlates with improvement in the illness severity.

A randomized, open-label pilot trial of selective serotonin reuptake inhibitors on neuropsychological functions in patients with obsessive compulsive disorder.

BACKGROUND: There is enough empirical literature suggesting impairments in neuropsychological functioning in patients with obsessive compulsive disorder (OCD) despite inconsistencies. AIM: The aim of the index study was to study the effect of Selective Serotonin Reuptake Inhibitors (SSRIs) on neuropsychological functions and illness severity in drug-naïve subjects with OCD. METHODS: A total of 50 subjects with diagnosis of obsessive-compulsive disorder (DSM-5) in the age range of 18-55 years, drug naïve, without comorbid depression/anxiety disorders were randomized to receive either Sertraline or Fluvoxamine. Neuropsychological functions and severity of illness were evaluated using NIMHANS neuropsychological battery and Y-BOCS at baseline and 12 weeks posttreatment with SSRIs. RESULTS: At baseline, study subjects had moderate severity of OCD and neuropsychological functions were impaired in a substantial number of subjects. More than half of the subjects were having impairment in verbal fluency and category fluency i.e., executive function impairment; the scores for DSST, DVT (assessing mental speed and sustained attention), Verbal N Back 1 error (assessing verbal working memory) WCST total trials (assessing set shifting) were found to be significantly correlated with Y-BOCS score i.e. severity of illness. Significant improvement was observed in both the illness severity and neuropsychological functions at end point. The proportion of adequate performers on various neuropsychological tests increased significantly at 12 weeks. CONCLUSION: A substantial number of patients with OCD have neuropsychological impairments, however, the pattern of impairments does not follow any sequence. Adequate management of OCD with SSRIs leads to improvement in both illness severity and neuropsychological functions in the short term.

Early Improvement as a Predictor of Treatment Response in Patients With Obsessive-Compulsive Disorder: A 12-Week Randomized Trial of Sertraline and Fluvoxamine.

Objective: Early response to selective serotonin reuptake inhibitors (SSRIs) at 4 weeks may predict response at 12 weeks. The objective of this study was to examine if early response to SSRIs can reliably indicate future response to the same drug, while simultaneously comparing 2 medications frequently used to treat obsessive-compulsive disorder (OCD): sertraline and fluvoxamine.Methods: This was a randomized, open-label prospective study of 50 drug-naive patients with OCD (per DSM-5 criteria) conducted from January 2019 to November 2020 in the outpatient department of a tertiary care teaching hospital in North India. Patients were randomly assigned to receive either sertraline or fluvoxamine after assessing the severity of illness with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Following the induction phase of treatment for 2 weeks, patients were assessed for early response, defined as ≥ 20% reduction in YBOCS score after 4 weeks of reaching the minimum therapeutic dose of each drug. The final YBOCS assessment to evaluate response was conducted at 12 weeks.Results: A total of 60% (n = 30) of patients with OCD showed early response at week 4 with a mean dose of sertraline 95 mg and fluvoxamine 102 mg/d. Both drugs showed significant reduction in YBOCS score at week 12. However, fluvoxamine fared significantly better than sertraline (P = .012).Conclusions: The study results show that early response can predict future response to the drug with a good sensitivity and specificity.Trial Registration: Clinical Trial Registry of India: CTRI/2020/01/022890.

Lived Experiences of Wives of Persons with Alcohol Dependence Syndrome during COVID-19 Pandemic.

Background: There have been reports of increasing alcohol use and domestic violence among individuals with alcohol dependence syndrome during the COVID-19 pandemic. This study assessed the experiences of domestic violence, psychological distress, and coping mechanisms used by wives of individuals with alcohol dependence syndrome (PWADS) during the COVID-19 pandemic. Materials and Methods: This cross-sectional institutional-based study collected data from 50 participants using the consecutive sampling method. The following tools were utilized: Socio-demographic Questionnaire, Domestic Violence Questionnaire, the Kessler Psychological Distress Scale, and the Brief Cope. Results: The mean age of the spouses (PWADS) was 42 ± 8.20 years, with 42% (N = 21) being skilled workers. Sixty percent (N = 30) had been consuming alcohol for the past 10 years, and 50% (N = 25) had been undergoing treatment for 2-5 years. Among the study participants (wives of PWADS), the mean age was 40.70 ± 8.70 years, and 82% were housewives. They reported a significant increase in alcohol use and excessive spending by their husbands, which negatively affected the home environment. Domestic violence, in terms of psychological, physical, and sexual abuse, also significantly increased (p < .001) compared to before and during the lockdown. Forty-eight percent of the wives reported experiencing severe levels of psychological distress. They employed various coping strategies. Conclusion: The lived experiences of wives of individuals with alcohol dependence syndrome during the COVID-19 pandemic were challenging, as their husbands not only continued their regular alcohol consumption but also increased the amount and expenditure on alcohol. This had a detrimental effect on the home environment, worse than the situation before the lockdown. Targeted interventions are necessary to address these issues during the COVID-19 pandemic or similar situations.

Psychiatric morbidity and substance use in migrant workers: A population based study.

BACKGROUND: The prevalence of mental health problems and substance abuse in the migrant population is higher than the general population. AIMS AND OBJECTIVES: To assess the prevalence and pattern of mental health issues and substance use in the migrant population and highlight the association with the reverse migration of migrant workers. METHODOLOGY: The field staff visited the shelter homes for migrant population in four cities of Northern India (Chandigarh (UT), Bhatinda (Punjab), Panchkula (Haryana) and Jaipur (Rajasthan). After maintaining the social distance and wearing masks by the staff and migrants, written informed consent was taken for participation in the study. The socio-demographic details of reverse migrants were noted down and Hindi version of Patient Health Questionnaire (PHQ-9) for mental health problems and screening tool for pattern of substance abuse was administered. Geographically matched undisplaced were also administered these tools. RESULTS: A total of 275 reverse migrants and 276 undisplaced were included in the study. The prevalence of ever use for all the substances among reverse migrants was 44.4% (122/275) and among undisplaced, it was 45.3%. The prevalence of alcohol, tobacco and cannabis was higher than the general population. The prevalence of at least one diagnosis on PHQ-9 is 13.45% (reverse migrants 19.3% and undisplaced 7.6) and the prevalence of other depressive disorder is significantly higher in reverse migrants (17.1%) than undisplaced (4.0%). CONCLUSION: The study concludes that prevalence of mental health issues and substance abuse in migrant population is significantly higher than the general population and the prevalence of at least one diagnosis and other depressive disorder is significantly higher in reverse migrants than undisplaced.

Impact of the COVID-19 Pandemic on Psychiatric Hospitalization in a Tertiary Care Hospital of Northern India.

Objective: To study the pattern of admissions in a psychiatry ward during the coronavirus disease 2019 (COVID-19) pandemic and compare the sociodemographic and clinical profiles of patients admitted in 2020 with admissions in 2019.Methods: The case record files of an inpatient psychiatric unit from March 23 to September 22, 2019, and March 23 to September 22, 2020 were retrieved. Sociodemographic data, admission criteria of the patients, clinical diagnosis (as per ICD-10 criteria), duration of stay in the ward, and details of capacity assessment were assessed. The data collected were tabulated as per coding system and analyzed and compared using statistical analysis system software.Results: Of a total of 312 admissions, 236 were in 2019 and 76 were in 2020 (P < .05), which was a significant (P < .05) decrease. More patients admitted in 2020 were in the age group of 30-39 years (P < .05), were residents of Chandigarh (P < .05), were housewives by occupation (P < .05), had incomes < 3,500 Indian rupees (US$ 48.01) per month (P < .01), were Hindu, and belonged to extended families (P < .05). The predominant reasons for admission in 2020 were complicated withdrawals, noncompliance to treatment (P < .05), and aggravation of psychiatric illness due to comorbid substance use. The ICD diagnoses schizophrenia, schizotypal and delusional disorder (F20-29) and mood disorders, predominantly mania (F30-31) were significantly higher and mental and behavioral disorder due to psychoactive substance use (F10-19) was lower among patients admitted in 2020.Conclusions: The results show that the numbers of admissions to the psychiatry ward in 2020 were significantly lower than pre-COVID 2019, and the predominant reasons for admission were complicated withdrawals due to psychoactive substance abuse and noncompliance to treatment. Also, the mean duration of stay was longer in 2020 compared to the previous year.

Coping With Craving and Withdrawal Due to Substance Use Disorders During the COVID-19 Lockdown.

OBJECTIVE: Substance use disorder (SUD) is a chronic remitting and relapsing disorder, and abrupt discontinuation of the substance due to nonavailability in the absence of treatment precipitates withdrawals and craving. The objective of this study was to assess the craving and withdrawal coping mechanisms used by patients with SUDs as a result of disruption in availability of substances and medications due to sudden lockdown in response to coronavirus disease 2019. METHODS: A survey was administered via telephone from June 25, 2020, to July 15, 2020, to patients who had previously attended the substance use clinic of a tertiary care teaching hospital in North India from January 1, 2020, to March 21, 2020 (up to the time of lockdown). Sociodemographic and clinical details were obtained from case record files. A 16-item questionnaire was developed to collect information on coping with craving and withdrawal symptoms. A total of 215 patients were registered in the substance use clinic during this period for the treatment of SUDs, and of those, 43 could not be contacted due to various reasons such as wrong contact numbers, patient expired (not related to substance withdrawal), or not willing to talk. The mean age of the subjects was 37.05 (SD = 13.22) years, and men outnumbered women. The remaining 172 patients were contacted via telephone, and responses were gathered regarding withdrawal symptoms and coping with craving. RESULTS: More than two-thirds of the patients were still maintaining abstinence from their primary substance of abuse during lockdown. A large number of patients (n = 41, 43.2%) reported difficulty in obtaining prescribed medication for detoxification without renewal of their prescription. More than 66% of patients reported that they were able to control their craving, and many kept themselves busy with household activities. CONCLUSIONS: The majority of patients who had completed the acute phase of withdrawals were able to maintain abstinence in the absence of renewal of prescribed medication and substance of abuse due to sudden disruption in supply. The patients were able to use certain strategies to control their craving.

Factors Leading to Reverse Migration Among Migrant Workers During the COVID-19 Pandemic: A Multicenter Study From Northwest India.

OBJECTIVE: To examine the various psychosocial factors associated with reverse migration among migrant workers during the coronavirus disease 2019 (COVID-19) lockdown in India. METHODS: A cross-sectional multicenter study was conducted at 4 sites in Northwest India. The migrant workers were recruited from various shelter homes, and information was gathered from reverse migrant workers and controls using various tools including a sociodemographic profile; knowledge, attitudes, and practices questionnaire; and reasons for migration and reverse migration questionnaires. A total of 275 reverse migrant workers and 276 controls participated in the study. RESULTS: There was a considerable difference between reverse migrant workers and controls regarding the question of whether it was safe to travel during lockdown (76.0% vs 26.4%, respectively). The most common route of spread of COVID-19 infection was through touching and sneezing, and symptoms were fever, dry cough, and sore throat in both groups. Reverse migrant workers had low self-esteem and were reluctant to participate in customs of their migration city. A large number of reverse migrant workers reported that they had no money to survive, worried about family back home at their village, felt pressured by family members to come back to the village, and had been terminated from their job. CONCLUSIONS: Reverse migrant workers had the attitude that it was safe to travel during the lockdown. About one-fifth of the reverse migrant workers reported no place to live and fear of getting an infection. The reverse migrant workers also reported feeling low and gloomy, restless, and uncertain about the future and fear of death. Lack of jobs was a major factor driving migrant workers from their native homes.

Clinical Hypnotherapy in Grief Resolution - A Case Report.

Grief is one's reaction to any loss, and the coping mechanisms during grief either deplete or become maladaptive. One of the common ways to cope with grief is alcohol or substance intake. The course and resolution of grief vary depending upon many factors. Hypnotherapy has been useful and effective in addressing grief reactions as well as associated manifestation, such as sleep problems, depressive features, or post-traumatic stress disorder. It might be a good choice of treatment while dealing with patients having underlying issues or maladaptive coping mechanisms. This is a single case study design hypothesized to indicate maladaptive coping of increased alcohol consumption to deal with the death of a young son. The case had been treated as alcohol dependent syndrome with multiple hospitalizations without addressing underlying grief. The treatment approach was changed, and grief was addressed using hypnotherapy. Clinical hypnotherapy helped address grief and facilitated the index case to accept the loss. This resulted in minimizing hospitalizations, abstinence and improved day-to-day functioning along with the use of adaptive mechanisms to cope with the loss. Clinical hypnotherapy is an effective intervention to deal with underlying conflicts or issues that may not be addressed directly in a therapy setting.

Effects of abstinence of alcohol on neurocognitive functioning in patients with alcohol dependence syndrome.

AIMS: Alcohol dependence causes impairment of neurocognitive functions. Abstinence for some time leads to improvement in neurocognitive functions. This study was conducted with the aim to observe the effects of abstinence on neurocognition. METHODS: The current study was an observational, single group with longitudinal design exploring the effect of abstinence on neuropsychological functioning and further exploring correlation of clinical factors with neuropsychological functioning in patients with Alcohol Dependence Syndrome (ADS). Sixty consecutive male patients of ADS meeting inclusion and exclusion criteria were inducted. Neurocognitive tests were applied at baseline, one month and three months of abstinence. RESULTS: All neurocognitive functions showed significant improvement at three-time intervals (p < 0.05) except for visuomotor function, for which improvement was statistically insignificant (p > 0.05) at one month. The difference for scores on verbal fluency, working memory, set-shifting (WCST total trials and perseverative errors) and visuomotor function from 0 to 3 months was significant (p < 0.05). There was significant interaction (p < 0.05) between duration of regular but non-dependent use, total duration of use, duration of dependence, average intake per day, last intake and time period with verbal fluency, working memory, set -shifting (for WCST total trials, total errors, perseverative errors and non-perseverative errors) and visuomotor function. CONCLUSION: The study showed improvement in neurocognitive functions with abstinence over three months, suggesting the need to address these cognitive deficits in the early part of abstinence. Also, correlates for drinking history were identified which may help in the future for the prevention and management of cognitive deficits in ADS patients.