Long-term impact of the COVID-19 pandemic on obsessive-compulsive disorder.

There is limited data on the long-term effect of the COVID-19 pandemic on obsessive-compulsive disorder (OCD). We report on the course of a cohort of individuals with OCD followed-up over a period of one year during the first wave of the COVID-19 pandemic in India. A cohort of 240 individuals registered at a specialty OCD clinic was regularly followed-up using standardized rating tools at three months, six months, and one year into the onset of the COVID-19 pandemic in India. These were compared with clinical ratings recorded in a comparable historical cohort of 207 individuals with OCD, followed up during a non-pandemic year. The pandemic and non-pandemic (historical control) cohorts did not differ in illness severity and rate of relapse. It was found that COVID-19-related anxiety declined over time. Among those patients who were treatment responders prior to the pandemic, COVID-19-related anxiety and non-adherence to medication predicted a relapse of symptoms. Contrary to our expectations, the rate of relapse and illness trajectory in the pandemic cohort did not differ from the non-pandemic cohort, suggesting that the pandemic did not impact our largely medication-adherent cohort. Adherence to treatment seemed to have a protective effect during the pandemic.

Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Socio-demographic and clinical characteristics of patients admitted at the Lunatic Asylum, Bengaluru (now NIMHANS) and treatment outcome in the early 20th century (1903-1911).

OBJECTIVE: Historiography of South Asian mental asylums is generally skewed towards asylums operated by the British. The Lunatic asylum, Bengaluru, later to become NIMHANS, was one of the early asylums and was administered by a princely state (Mysore). This study aims to evaluate socio-demographic and clinical characteristics as well as the treatment outcome of patients admitted to the Lunatic Asylum, Bengaluru in the early 20th century (1903-1911). METHODS: A review of inpatient registers at the Lunatic Asylum, Bengaluru was conducted for the years 1903-1911 and analysed using descriptive statistical methods. RESULTS: There were 620 admissions during this period and three-fourths were men (n = 465, 75.0 %). The mean age of the patients was 32.09 ± 10.29 years at the time of admission. Acute mania (n = 209, 33.7 %), chronic mania (n = 125, 20.2 %) and dementia (n = 65, 10.5 %) were the most frequent diagnoses. At the time of discharge, 35.5 % reported being cured and 12.1 % improved. The overall death rate of patients at the asylum was 27.2 %. Subjects who died had a mean duration of in-patient stay of 11.9 years. The mean age at death was 45.7 years with the comparable life-expectancy of the general population during the period being around 23 years. CONCLUSIONS: In-patients in the Lunatic Asylum, Bengaluru in the pre-antipsychotic era had a good outcome with approximately 50 % being cured or showing improvement and longer life expectancy than the general population.

Impact of the COVID-19 Pandemic on the Short-Term Course of Obsessive-Compulsive Disorder.

ABSTRACT: There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic ("pandemic" cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41-1.59; p = 0.535). Preexisting contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.