Role of Pre-Operative High-Resolution Computed Tomography for Surgical Planning in Patients Undergoing Cochlear Implantation - An Observational Study.

Background: Currently preoperative magnetic resonance imaging (MRI) brain and High-Resolution Computed Tomography (HRCT) scanning of temporal bones form part of routine Cochlear implantation (CI) assessment. Pre- operative imaging demonstrates anatomic details or anomalies if any, that prove essential in pre-surgical evaluation of patients. These form a road map for the surgeon to anticipate any difficulty during surgery, to aid in decision making to implant the most appropriate ear, plan surgical technique, or select electrode arrays. Methods: A descriptive observational pilot study was conducted at tertiary care hospital involving 51 paediatric patients worked-up for CI. Patients after detailed clinical evaluation and MRI Brain, a tentative surgical plan was formulated by a candidacy CI screening committee. Patients selected for surgery underwent HRCT temporal bones and surgical plan was modified after analysing the same. Percentage of cases in which surgical plan changed (in terms of laterality of surgery) after correlating with HRCT findings were determined and data analysed. Results: A total of 51 patients worked up for CI were included in the study. In 37.3% cases, there were unfavourable MRI findings. HRCT scan was used to aid the surgical road map in these patients, which based on MRI findings would have had suboptimal outcome. Conclusion: With this understanding, we recommend that, MRI with precise interpretation would be sufficient to furnish all necessary information in preoperative assessment of CI patients, and a HRCT temporal bones maybe indicated only in difficult cases or those with unfavourable MRI findings, may aid predict surgical events.

Building psychological resilience in Armed Forces worldwide.

Psychological resilience among troops can be enhanced through relatively simple interventions. Globally, various Armed Forces have successfully implemented modules for building psychological resilience. Programs from different countries are listed, evaluated and their underpinnings explored. Recommendations for a variety of feasible and culturally acceptable interventions targeted at individuals, families, units, community and organizations in the Indian context have been made; ranging from mindfulness training to embedded combat psychologists. Interventions are likely to succeed if integrated within existing basic training and unit/career programs.

Longitudinal study of the course and outcome of first-episode psychosis.

Background: Study of first episode psychosis (FEP), an episode of psychotic nature, which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been a matter of research interest in recent years, as this may give more insight to the overall phenomenology and course of psychotic illnesses. Methods: A study was undertaken to evaluate course and outcome of first episode psychosis. A total of 100 consecutive inpatients were selected for the study. Informed consent was obtained. Structured Proforma was used for recording psychosocial profiles and relevant medical history. Brief Psychiatric Rating Scale (BPRS) was given to assess the severity of psychopathology; Positive and Negative Symptom Scale (PANSS) to assess the severity of psychosis; Becks Suicidal Ideation Scale (BSI) to assess the extent of suicidality and Global Assessment of Functioning (GAF) to assess global functioning of the individual. The assessment was done at baseline, at six months, and at one year. Results: First episode psychosis constituted around a tenth of the caseload. It commonly affected people in the third decade of life. There was an improvement in 92% of the cases over a year of study. Schizophrenia constituted the majority of first episode psychosis. The history of smoking was relatively higher in acute and transient psychotic disorders. Age inversely correlated with the severity of psychopathology. There was no difference in improvement in psychopathology over time in patients of schizophrenia and related disorder vis--vis other psychotic disorders. Conclusion: Our study did not find any significantly varied sociodemographic factors in the course and outcome of the illness. It also refuted the schism between various types of psychosis based on the current classificatory system. It draws our attention toward the unitary concept of psychosis and is a call to re-think our strategies in the management of psychosis.

Impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer.

Background: Mothers of children diagnosed with cancer are found to have coping difficulties in various studies. Most of the studies were done on parents after their child has been newly diagnosed with malignancy, and very few studies were done on coping skills intervention. Hence, this study has been done to assess the impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer. Methods: Twenty mothers coming to the outpatient department of paediatric oncology from 01 September 2018 to 30 April 2019 were enrolled for the study. The participants were administered General Health Questionnaire, Brief Coping Operation Preference Enquiry Scale, Zung Self-Rating Anxiety Scale, and Coping Inventory for Stressful Situations-21 (CISS-21) Scale. Sixteen sessions of cognitive behavioural intervention were given over 8 weeks to all the participants. Reassessment was done after 3 months by use of the above mentioned scales. Results: Participants' mean anxiety score was 49.40 (standard deviation [SD] ±8.89). They used adaptive (active coping and positive reframing) more than the maladaptive (denial and self-blame) coping strategies. Task- and emotion-focused coping mean score on CISS-21 revealed 19.25 (SD ±6.20) and 18.90 (SD ±5.76), respectively. Reassessment after cognitive behavioural intervention revealed statistically significant improvement in maladaptive coping styles, mean anxiety index score, avoidance, and emotion-focused coping. Conclusion: The study has revealed mild to moderate anxiety and the use of both adaptive and maladaptive coping strategies by participants. There is statistically significant improvement in anxiety, maladaptive coping strategies with cognitive behavioural intervention.

Positive mental health for all serving the under-served.

Mental disorders are major contributors to global burden of disease measured in Disability Adjusted Life Years (7% of all disease burden in 2017). Large treatment gaps for these disorders exist in all parts of the world. In India, overall treatment gap for mental disorders was found to be 83%. Women, children and adolescents, ethnic minorities, LGBTQ+ community, elderly and those living in remote and inaccessible areas have disproportionately higher rates of mental illness. They face unique and characteristic barriers to access to mental healthcare which increases treatment gap. These gaps have persisted despite global efforts and interventions to mitigate these barriers. Hence, there is a need to find alternatives to reduce mental health gap in these groups. Positive Mental Health interventions focuson well-being and health promoting activities, rather than on illness. The potential role of these interventions in promoting mental health and reducing treatment gap has been explored in this article.

Childhood trauma and bipolar affective disorder: Is there a linkage?

Bipolar affective disorder (BPAD) is a major psychiatric illness impairing the quality of life. The etiology of BPAD is influenced by different factors possibly related to gene-environment interactions. Approximately 30% to 50% of individuals with BPAD have experienced some traumatic event in childhood. Serious adverse experiences that children may suffer early in life are often described as childhood trauma (CT). It includes physical, emotional, and sexual abuse and physical and emotional neglect. CT is linked with an elevated risk of developing BPAD. Childhood adversities play a role in modulating the early onset of illness, increased number of depressive episodes, increased suicide attempts, and other clinical severity of BPAD. Hospital-based studies comprising heterogeneous populations had researched the specific role of each trauma subtype as a predisposing factor for BPAD. Identifying and addressing CT through early intervention methods may prevent the future development of chronic disorders like BPAD. This review article is an attempt to explore and highlight the existing literature regarding the association of different subtypes of CT with BPAD.

Augmenting mental health literacy of troops in a large military station: A novel approach.

Background: Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops. Materials and Methods: 1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months. Results: Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months. Conclusions: Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

Where, when, and to whom gaming motives may be harmful? A systematic review.

The alarming growth in online gaming activities in recent years calls for an understanding of the determinants of gaming behaviors among adolescents and young adults. A systematic review was conducted to collate and review all the research studies concerning the understanding of the gaming motives. Relevant published articles were identified through the electronic search from PubMed, Medline, PsycInfo, Sciencedirect, and APA databases. The review identified four major topics of gaming motives, namely gaming behavior, gaming usage pattern, gaming demographics, and associated psychopathology. The review highlighted the role of motives in gaming use and psychopathology. The age of the player was associated with the expression of these motives. Further insights were drawn into the role of motive in the recreational and problematic use of gaming. The study findings emphasize the need to develop adequate interventions to prevent the occurrence of psychological impairments that would result from potentially problematic video gaming.

Cognitive behavior therapy as an adjuvant in management of alcohol dependence syndrome.

Background: Treatment of alcohol dependence is a major challenge due to frequent relapses. Cognitive-behavioral therapy (CBT) has been reported to be useful in the treatment of alcohol dependence. Aim: This study aims to evaluate the effect of CBT module in management of Alcohol Dependence and compare it with treatment as usual (TAU). Materials and Methods: All newly diagnosed alcohol dependence patients during the study period meeting the exclusion and inclusion criteria were included in the study. Patients with a head injury, HIV seropositive status, or any other organic brain disorder and comorbid psychiatric disorders were excluded. The study included 226 patients with alcohol dependence randomly assigned to intervention group (n = 116) and TAU group (n = 110). Demographic and clinical data were recorded and Severity of Alcohol Dependence Questionnaire was applied. Relapse was taken as an outcome variable. Both TAU group and experimental group were followed on standard protocol of treatment. Results: The data were analyzed and relative risk (RR) was calculated. Findings revealed the study group receiving CBT had a better outcome and relapse rate was also significantly low in the experimental group as compared to the TAU group. Conclusion: The RR of relapse is lower in patients of alcohol dependence on CBT within 6 months and within 1 year as compared to cases on TAU. It is recommended that CBT be used as an adjunct to treatment in alcohol dependence cases.

A study of family-related factors associated with scholastic backwardness in urban lower middle class school children.

Introduction: Causes of scholastic backwardness in a child may be internal or external. The external factors include the factors related to the family the child is living in, and these factors are usually under-estimated in assessing contribution to scholastic backwardness. Aims: The aim of this study is to study the family factors associated with scholastic backwardness in school-going children in Pune Cantonment. Materials and Methods: Three hundred school children aged 8-14 years studying in Class III to IX from two government aided semi-Marathi Schools in Pune Cantonment were screened for scholastic backwardness, and evaluation of family-related factors was carried out for positive cases and matched controls. Results: Significant association was found between scholastic backwardness and such family factors as maternal education, chronic illness in the family members, and family problems such as domestic violence and substance abuse (P < 0.05). Conclusions: The family a child lives in plays an important role in determining the scholastic performance of a child. Adverse impact on the child's performance can be made by such variables as low maternal education, chronic illness in one or more family members, and poor family environment. Management strategies and policies aimed at correcting these preventable cause would ensure that they are identified and remedied at an early stage to ensure optimum scholastic performance by children.

Mental health impact of COVID-19 among health-care workers: An exposure-based cross-sectional study.

BACKGROUND: Health-care workers (HCWs) in COVID-19 pandemic have faced the major impact in providing care to infected persons. Most of the studies on mental health impact among HCW have not incorporated paramedical staff. Furthermore, they have not compared psychological morbidity among HCW on the basis of high COVID exposure (HCE) and low COVID exposure (LCE). To address the above gap, this study aimed at evaluating mental health impact among HCW and its associated risk factors. MATERIALS AND METHODS: Consecutive 200 HCWs each in the HCE and LCE groups (between the age group of 18 and 60 years) were enrolled from two tertiary care hospitals providing COVID-19 treatment from August 1, 2020. After collection of sociodemographic data, participants were administered Impact of Event Scale-Revised, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 Scale. RESULTS: The difference in stress, depression, and anxiety symptom scores between the HCE and LCE groups was not statistically significant. Multiple regression analysis revealed that female sex was associated with higher scores in all the three domains. The effect remained significant even after adjusting for effect of other risk factors. CONCLUSION: HCE or LCE was associated with similar impact in terms of stress, depression, and anxiety among HCWs. Female HCWs had a higher prevalence of stress, depression, and anxiety. Doctors, nurses, and paramedics had a similar prevalence of stress, depression, and anxiety when odds were adjusted.

Gut-brain axis: Synergistic approach.

Since decades, there is a change in concept of the gut-brain axis. There is differential increase in evidences focusing on the bidirectional communication between the gut microbiome and the brain. It supports existence of far-reaching model of "gut-brain axis." This axis is attaining more adherence to fields investigating biological and physiological footing of psychiatric, neuro-developmental, age-related, and neurodegenerative disorders. Many factors can change microbiota composition in early life as well as with the increasing age. Stress can affect the microbiota-gut-brain axis at every stages of life. Recent advances have involved the gut microbiota in many conditions including severe mental illness, autism, anxiety, obesity, Parkinson's disease, and Alzheimer's disease. The current studies target on elaborating the underlying mechanisms of microbiota-gut-brain axis and attempt to exemplify intervention and therapeutic strategies for neuropsychiatric disorders.

Transient global amnesia following deliberate self-harm by hanging: Case report and review.

A 25-year-old female was hospitalized subsequent to an attempt to hang herself. She was unconscious for a few minutes but responded to initial resuscitative measures. Relevant investigations, including X-ray neck, computed tomography scan brain, and electroencephalogram were normal. Physical examination was consistent with attempted hanging. On mental status examination, speech was relevant. Mood was euthymic. Attention was arousable, but concentration was impaired. Orientation to time and recent memory were impaired. Remote memory, insight, and judgment were unimpaired. Serial Mental Status Examination (MSE) revealed improvement in concentration and orientation. Due to sudden onset memory loss of <24 h in duration without other signs of cognitive impairment or concomitant focal neurological symptoms, she was diagnosed as a case of transient global amnesia. The pathophysiology of the condition is briefly reviewed.

Study of psychological effects of deployment at extreme high altitude area on soldiers.

BACKGROUND: The Indian Armed Forces are fighting the battle at extreme High Altitude, the most inhospitable terrain in the world, for the last thirty five years. The stress of being isolated under harsh environmental conditions on a daily basis can have an adverse effect on their mind. However, so far, no study has been undertaken to assess the psychological effects of deployment at extreme High Altitude. METHODS: Three hundred thirty-four troops selected for deployment were initially evaluated using the General Health Questionnaire-12 (GHQ-12) and Armed Forces Medical College Life Events Scale (AFMC LES) as screening tools to assess mental health status after obtaining ethical clearance and informed consent. On deinduction after a deployment for more than three months, they were reassessed. The data collected were statistically analysed. RESULTS: As per GHQ-12 evaluation, after the deployment score increased from 0.2574 to 0.9162, but remained lower than the 'caseness' level of 2. Among the 79 troops with a score of 2 and more, the majority were married and had past history of tenures at high-altitude areas. There was statistically significant increase in the AFMC LES scores also on deployment. CONCLUSION: Deployment at extremely high-altitude areas for even three months produces significant psychological morbidity among troops.

Perceived stigma among the patients of coronavirus disease-19 admitted at a dedicated COVID-19 hospital in Northern India: A cross-sectional study.

BACKGROUND: Coronavirus disease-related stigma started early in the pandemic with multiple media reports highlighting the discriminatory practices toward the health-care workers, patients, and survivors. MATERIALS AND METHODS: A cross-sectional study was conducted in a designated COVID -19 hospital in Delhi from 22 October 20 to 21 November 20. All patients admitted to the hospital for more than 72 h were eligible for participation in the study. Anyone without a mobile phone and not able to read was excluded from the study. The data were collected using a pretested, prevalidated questionnaire. RESULTS: One hundred and twenty-two (92.4%) patients answered the questionnaire. All patients were male. A total of 54 (44.26%: 95% confidence interval [CI] 35.3-53.5) COVID-19 patients blamed themselves for getting the infection, compared to 68 (55.74% 95% CI: 46.5-64.7) patients who believed that acquiring the disease was not their fault. There was a statistically significant association between feeling ashamed and blaming themselves for COVID-19 (P = 0.046). A total of 19 (15.6%) have reported that they have been told that getting COVID-19 is your fault. CONCLUSION: The stigma related to COVID - 19 needs to be tackled with multipronged strategy. In India, it is not a routine to assess mental health; however, the current pandemic has brought forward the importance of stigma and other related issues during the pandemic.

Critical appraisal of journal article by psychiatry PG residents using a new module: Impact analysis.

BACKGROUND: A gap exists from evidence-based medicine (EBM) to clinical practice and there is a felt need to bridge this. Critical appraisal of scientific articles during Journal club by postgraduate (PG) residents will help them to understand and apply the scientific evidence into best clinical practice. Hence, a new module of critical appraisal of journal articles was used for Psychiatry Residents in a Medical College and its impact was assessed. MATERIALS AND METHODS: Nine psychiatry PG residents from three academic batches participated in the study after informed consent and Institutional ethical committee clearance. They were trained in the Colorado Psychiatry EBM Examination Test module. Subsequently, three consecutive journal article presentations of them were assessed under seven Subtests of the module. RESULTS: There was gradual increase in the assessment scores of all PG residents with each journal article presentation. They also expressed satisfaction of the assessment method and felt confident of applying the principles of critical appraisal in their clinical practice in future. CONCLUSION: This study evaluated the impact of a new module of critical appraisal of journal article by psychiatry PG residents. It was found to be acceptable by residents and improved their competency to apply literature-based EBM into their clinical practice. It is recommended for further multicentric evaluation on a larger sample.