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.

Impaired mother-infant bonding: a community study from India.

PURPOSE: Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking. METHODS: The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant. RESULTS: The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model. CONCLUSION: Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.

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.

Does academic streams influence alcohol use in colleges?

BACKGROUND: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. AIMS: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. SETTINGS AND DESIGN: This is a cross-sectional survey conducted among college students. MATERIALS AND METHODS: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. STATISCAL ANALYSIS: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. RESULTS: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing "other" stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. CONCLUSION: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.

Naturalistic outcome of medication-naïve obsessive compulsive disorder treated with serotonin reuptake inhibitors.

OBJECTIVE: The data on the course of obsessive compulsive disorder (OCD) is mostly derived from studying chronic, severely ill patients with varying degree of treatment resistance. We studied the course and outcome of OCD patients who were medication-naïve at initial assessment compared to those who were medicated. MATERIAL AND METHODS: We analyzed the clinical chart data of all patients with a primary diagnosis of OCD attending a speciality OCD clinic in India during a specified period and compared outcome between medication-naïve (n = 75) and medicated (n = 117) patients. RESULTS: The mean time to remission was shorter in the medication-naïve [18.99 months (95 % CI: 14.61-23.37)] compared to medicated [33.91 months (95 % CI: 27.55-40.28)] patients. The survival distribution of the two groups was significantly different as per the log-rank test (χ2 = 5.76, p = 0.02). In the Cox proportional hazards regression, medication-naïve status predicted time to remission. Overall, the rate of remission was the same in both groups (57 %). CONCLUSIONS: Medication-naïve OCD patients seem to remit faster than the previously treated patients. Future prospective naturalistic studies can compare the outcome of medication naïve OCD patients treated with medications and CBT.

Transcranial direct current stimulation for treatment-resistant obsessive-compulsive disorder-A large case series.

OBJECTIVE: The present study is a large case series evaluating the benefits of transcranial direct current stimulation (tDCS) in treatment-resistant obsessive compulsive disorder (OCD). METHODS: We reviewed the charts of 32 patients with treatment-resistant OCD who received 10-20 sessions of anodal pre-SMA tDCS. RESULTS: Overall, 9 (28 %) showed at least partial response to tDCS at the end of 10-20 sessions [responders = 8 (25 %), partial responders = 1 (3%)]. Two out of three partial responders at the end of 10 sessions had response at the end of 20 sessions. CONCLUSIONS: tDCS may benefit a proportion of patients with treatment-resistant OCD.

Prevalence of hoarding disorder among primary care patients

Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

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.

Prevalence of hoarding disorder among primary care patients.

OBJECTIVES: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. METHODS: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. RESULTS: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. CONCLUSION: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder.

Glutamate modulators are used to treat OCD resistant to serotonin reuptake inhibitors (SRIs). Ketamine has shown some promise in treating OCD. Data on the use of ketamine in SRI-resistant OCD is limited, with no studies on the role of multiple ketamine infusions in this disorder. We report our experience of treating SRI- resistant OCD with multiple ketamine infusions. We reviewed the clinical charts of 14 adult inpatients with a diagnosis of SRI-resistant OCD and treated them with repeated ketamine infusions [mean (SD) = 5.4 (2.5)]. There was a significant reduction in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score following intravenous ketamine infusions. One patient showed a dramatic response (a drop in the YBOCS to '0') and two patients showed a partial response (25-35 % reduction in the YBOCS). Eleven patients showed no clinical improvement. Ketamine may, therefore, be somewhat effective in a subset of OCD patients who are resistant to SRIs. Our findings suggest the need to examine the efficacy of ketamine in controlled studies with larger samples. It may be possible to identify predictors of response to ketamine in larger studies.

Deficits in Theory of Mind and Emotional Awareness in Somatoform Disorders.

INTRODUCTION: Emotions develop from a less differentiated to a highly differentiated level, and their arrest at a lower level is hypothesized to result in somatization. The present study aimed at investigating the Theory of Mind and emotional awareness in patients with somatoform disorders. MATERIALS AND METHODS: Twenty patients with somatoform disorders, along with 20 healthy controls matched for age, sex, and education, were recruited after obtaining informed consent. Assessments included semi-structured proforma for sociodemographic and clinical details; Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms; and Patients Health Questionnaire (PHQ) to assess somatic symptoms, depression, and anxiety. Emotional awareness was measured using the Levels of Emotional Awareness Scale (LEAS), in which the participants had to provide descriptions of feelings of self and the other person in 20 imaginary situations. The responses were scored using a standardized manual. The Theory of Mind was measured using the Social Cognition Rating Tool in Indian Settings (SOCRATIS). RESULTS: The two groups did not differ on any demographic parameters. Patients with somatoform disorders scored significantly lower on emotional awareness (t = -3.74; P < 0.001) and the Theory of Mind (t = -3.56; P < 0.001). The above differences remained significant even after controlling for comorbid depressive and anxiety symptoms. CONCLUSION: Patients with somatoform disorders are likely to have Theory of Mind and emotional awareness deficits independent of mood states. Future studies are needed to assess whether these deficits are trait- or state-dependent and whether they are cause or effect.

Prevalence and Clinical and Coercion Characteristics of Patients who Abscond during Inpatient Care from Psychiatric Hospital.

BACKGROUND: Patients absconding from psychiatric hospitals pose a serious concern for the safety of patients and public alike. Absconding is associated with an increased risk of suicide, self-harm, homicide, and becoming "missing" from society. There are only scarce data on profile and outcome of the absconding patients in India. AIMS: To study the prevalence and describe the clinical and coercion characteristics of patients who abscond during inpatient care from an open ward. METHODOLOGY: "Absconding" was defined as patients being absent from the hospital for a period of more than 24 h. This is an analysis of absconding patients out of the 200 admitted patients at a tertiary psychiatric hospital. Descriptive statistic was used to analyze the demographic, clinical, and perceived coercion profile and outcome. RESULTS: The absconding rate was 4.5 incidents per 100 admissions. Most of these patients were males, from a nuclear family, admitted involuntarily, belonging to lower socio-economic status, diagnosed with schizophrenia or mood disorder with comorbid substance use disorder and had absent insight. The MacArthur Perceived Coercion Scale score was 4.58 (±1.44), and 80% of the absconded patients felt subjective coercive experiences in most domains at admission. Out of the 9 absconded patients, 2 patients had completed suicides and one continued to remain untraceable. CONCLUSION: The absconded patients were males; admitted involuntarily; diagnosed with schizophrenia, mood disorder, and comorbid substance use disorder; and had absent insight and high perceived coercion. Absconding patients had the tendency to harm themselves and wander away from home.

Antipsychotic augmentation in the treatment of obsessive-compulsive disorder.

Most studies suggest that obsessive-compulsive disorder runs a chronic course. Only 40%-70% of patients respond to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). The most common pharmacological strategy used in clinical practice for partial responders to SSRIs is augmentation with an atypical antipsychotic. This article aims to review the efficacy, tolerability, and comparative efficacy of antipsychotics as augmenting agents in patients who showed inadequate response to SSRIs. In addition to case reports and case series, 15 randomized controls trials, 6 meta-analyses, and 3 expert guidelines have been examined. The findings suggest that one in three SSRI nonresponders improve with antipsychotic augmentation. The presence of comorbid tics and/or schizotypal disorder may predict a better response to antipsychotic augmentation. Among antipsychotics, risperidone, and aripiprazole have the best evidence, with haloperidol being considered second in-line owing to its unfavorable side effect profile. Guidelines recommend that antipsychotics be administered at a low-to-medium dosage for a duration not exceeding 3 months, with mandatory discontinuation if there is no response. Larger studies and head-to-head trials are needed to further explore this treatment strategy.

The role of personality disorders in obsessive-compulsive disorder.

Personality disorders are a common comorbidity in obsessive-compulsive disorder (OCD). The effect of comorbidity on the symptom presentation, course, and treatment outcome of OCD is being discussed here. OCD and obsessive-compulsive personality disorder (OCPD) though similar in their symptom presentation, are distinct constructs. Schizotypal disorder, OCPD, and two or more comorbid personality disorders have been found to be consistently associated with a poor course of illness and treatment response. Further research is needed to determine treatment strategies to handle the personality pathology in OCD.