Gestational exposure to benzodiazepines or z-hypnotics and neurodevelopmental disorders in offspring: Systematic review and meta-analysis.

INTRODUCTION: Benzodiazepine (BDZP) and/or z-hypnotic dispensing during pregnancy has increased globally, as have rates of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aimed to estimate the association between gestational exposure to BDZP and/or z-hypnotics and diagnosis of ASD or ADHD in offspring. METHODS: We searched MEDLINE, EMBASE, and SCOPUS from inception till December 2023 for relevant English-language articles. Outcomes of interest were risk of ASD and ADHD, two independent primary outcomes, in children exposed anytime during pregnancy to BDZP and/or z-hypnotics versus those unexposed. Secondary outcomes were trimester-wise analyses. Using a random effects model, we pooled the overall and trimester-wise hazard ratios (HRs), with 95% confidence intervals (CIs), separately for risk of ASD and ADHD. RESULTS: We found six eligible retrospective cohort studies and no case-control studies. There was no increased risk of ASD associated with anytime gestational BDZP and/or z-hypnotic exposure (primary outcome, HR, 1.10; 95% CI, 0.81-1.50; 4 studies; n = 3,783,417; 80,270 exposed, 3,703,147 unexposed) nor after first trimester exposure (HR, 1.15; 95% CI, 0.83-1.58; 3 studies; n = 1,539,335; 70,737 exposed, 1,468,598 unexposed) or later trimester exposures. A very small but significantly increased risk of ADHD was noted with anytime gestational exposure to these drugs (primary outcome, HR, 1.07; 95% CI, 1.03-1.12; 4 studies; n = 2,000,777; 78,912 exposed, 1,921,865 unexposed) and also with (only) second trimester exposure (HR, 1.07; 95% CI, 1.03-1.12; 3 studies; n = 1,539,281; 33,355 exposed, 1,505,926 unexposed). Findings were consistent in sensitivity analyses. CONCLUSION: Gestational exposure to benzodiazepines or z-hypnotics was not associated with an increased risk of ASD and with only a marginally increased risk of ADHD in offspring. Given the likelihood of confounding by indication and by unmeasured variables in the original studies, our findings should reassure women who need these medications for severe anxiety or insomnia during pregnancy.

Urbanization and psychosis: an update of recent evidence.

PURPOSE OF REVIEW: Urbanization, a complex global phenomenon, has a significant bearing on schizophrenia/psychosis burden through various socioeconomic and environmental factors. This review focuses on recent evidence (2019-2023) linking urbanization, schizophrenia, and the role of green space. RECENT FINDINGS: This review analyzed 43 articles that examined the correlation between urban birth or upbringing, urban living (urbanicity), and various schizophrenia/psychosis-related outcomes such as incidence, psychotic experiences, etc. The studies showed differing results across geographical locations. Socioeconomic factors like area deprivation, migrant status (ethnic density) and social fragmentation were independently associated with the risk of schizophrenia/psychosis irrespective of urbanicity. More recently, environmental factors such as green space reduction and air pollution have been explored in urban living conditions and were positively associated with an increased risk of schizophrenia/psychosis. SUMMARY: There is a need for further investigation in low and middle-income countries. The impact of urbanization-related factors and green space on the risk of schizophrenia/psychosis calls for appropriate governmental commitments toward structured and healthy urban planning.

Long-Term Changes in the Quality of Media Reporting of Suicide Following a Celebrity Suicide in India.

Online portals of selected English and local language newspapers and television channels were searched to identify suicide news reports published one year after the celebrity suicide (ACS). These reports (n = 1952) were compared with the corresponding period of the previous year, immediately following the celebrity suicide (ICS) (n = 2486), and a three-month period before the celebrity suicide (BCS) (n = 1381) to assess longitudinal changes in quality of media reporting. There was a decline in reporting of several potentially harmful characteristics over time such as mentioning the deceased's age and gender (p < .001 for both), and location of suicide (p < .001). The quality of media reporting of suicide was significantly better at one year compared to the period immediately following celebrity suicide. This change was mainly driven by an improvement in the reporting quality of English news reports while local language reports continued to remain poorly adherent to reporting guidelines.

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis.

Importance: The relative efficacy of ketamine and electroconvulsive therapy (ECT) in adults with major depressive episode (MDE) needs clarification. Objective: To compare depression rating outcomes with ketamine vs ECT in adults with MDE and to compare response and remission rates, number of sessions to response and remission, and adverse effects. Data Sources: Two investigators independently systematically searched MEDLINE, ScienceDirect, and Google Scholar databases using a combination of relevant Medical Subject Headings terms and free-text keywords from database inception through May 15, 2022, to identify relevant English-language trials. Study Selection: Parallel-group randomized clinical trials (RCTs). Data Extraction and Synthesis: Two investigators independently extracted data and assessed risk of bias. One-week posttreatment outcomes were pooled as standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes in random-effects meta-analyses. Main Outcomes and Measures: Efficacy outcomes were 1-week (or nearest) posttreatment depression ratings, 1-week (or nearest) study-defined response and remission rates, and number of sessions to treatment response and remission. Safety outcomes were reported adverse effects. Results: Five trials (ketamine group: n = 141; ECT group: n = 137) were meta-analyzed. The overall pooled SMD for posttreatment depression ratings was -0.39 (95% CI, -0.81 to 0.02; I2 = 45%; 5 RCTs). For this efficacy outcome, in a sensitivity analysis of methodologically stronger trials, ECT was superior to ketamine (SMD, -0.45; 95% CI, -0.75 to -0.14; I2 = 6%; 2 RCTs). ECT was also superior to ketamine for study-defined response (RR, 1.27; 95% CI, 1.06-1.53; I2 = 0%; 3 RCTs) and remission (RR, 1.43; 95% CI, 1.12-1.82; I2 = 0%; 2 RCTs) rates. No significant differences were noted between groups for number of sessions to response and remission and for cognitive outcomes. Key limitations were small number of studies, limited sample size, and high risk of bias in all trials. Conclusion and Relevance: The findings of this systematic review and meta-analysis suggest an efficacy advantage for ECT over ketamine in adults with MDE. These conclusions are tempered by the small number and size of existing trials.

Prevalence of suicidal behaviour among students living in Muslim-majority countries: systematic review and meta-analysis.

BACKGROUND: Assessing suicidal behaviours among students would help to understand the burden and enhance suicide prevention. AIMS: We aimed to determine the prevalence of suicidal behaviour among students living in Muslim-majority countries. METHOD: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted in Medline, EMBASE and PsycINFO. Meta-analyses were performed to pool the lifetime, 1-year and point prevalence rates for suicidal ideation, plans and attempts. RESULTS: From 80 studies, 98 separate samples were included in this analysis. The majority (n = 49) were from the Eastern Mediterranean, and 61 samples were of university students. The pooled prevalence of suicidal ideation was 21.9% (95% CI 17.4%-27.1%) for lifetime, 13.4% (95% CI 11.1%-16.1%) for the past year and 6.4% (95% CI 4.5%-9%) for current. The pooled prevalence of suicide plans was 6.4% (95% CI 3.7%-11%) for lifetime, 10.7% (95% CI 9.1%-12.4%) for the past year and 4.1% (95% CI 2.7%-6.2%) for current. The pooled prevalence of suicide attempts was 6.6% (95% CI 5.4%-8%) for lifetime and 4.9% (95% CI 3.6%-6.5%) for the past year. The lifetime prevalence of suicidal ideation was highest (46.2%) in South-East Asia, but the 12-month prevalence was highest (16.8%) in the Eastern Mediterranean. CONCLUSIONS: The study revealed notably high rates of suicidal behaviours among students living in Muslim-majority countries. However, the quality of studies, differences in regional and cultural factors, stages of studentship and methods of measurement should be considered when generalising the study results.

Publication of studies registered in Clinical Trials Registry of India: An audit of mood disorder research protocols from 2009-2019.

Background: Selective publication of studies has important scientific, ethical, and public health implications. Aim: We studied selective publication among mood disorder research protocols registered in the Clinical Trials Registry of India (CTRI) database. We also examined the frequency and nature of protocol deviations among the published articles. Methods: Using a systematic search strategy, we examined the publication status of all mood disorder-related research protocols registered in the CTRI database from inception till December 31, 2019. Logistic regression analysis was used to identify variables associated with selective publication. Results: Of 129 eligible protocols identified, only a third (n = 43, 33.3%) were published in literature; among those published, only 28 (21.7%) were placed in MEDLINE indexed journals. Protocol deviations were observed in more than half of the published papers (n = 25, 58.1%); many of these (41.9%) were related to sample size deviations, though, importantly, deviations in primary and secondary outcomes were also noted (16.2%). Retrospective registration of trials (odds ratio, 2.98, 95% confidence interval, 1.32-6.71) was significantly associated with publication; other variables, such as funding status or multicentric sampling, were not associated with eventual publication. Conclusions: Two out of three mood disorder research protocols registered in India do not translate into published research. These findings from a low- and middle-income country with limited spending on health care research and development represent wastage of resources and raise scientific and ethical concerns about unpublished data and futile patient participation in research.

Efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in focal hand dystonia: Systematic review of intervention trials.

We reviewed trials examining the efficacy of repetitive transcranial magnetic stimulation (rTMS) (seven trials) and transcranial direct current stimulation (tDCS) (seven trials) in focal and dystonia (FHD). Among tDCS trials, one randomized controlled trial and three quasi-experimental studies showed evidence of efficacy; these trials combined different types of stimulations or used tDCS along with neurorehabilitation. Four rTMS trials showed evidence of efficacy but differed in stimulation parameters. Risk of bias was noted in nearly all the trials. There is weak and inconsistent evidence for the efficacy of rTMS and tDCS administered alone or with other interventions in FHD.

Incidence and prevalence of depressive, anxiety, and insomnia symptoms among adult liver transplant recipients: A systematic review and meta-analysis.

OBJECTIVE: Psychological morbidity among transplant recipients may negatively impact post-transplantation outcomes. Our objectives were to compute pooled incidence and prevalence estimates for depressive, anxiety, and insomnia symptoms among adults who underwent liver transplant. METHODS: Electronic searches of MEDLINE, PubMed Central, CINAHL, and Google Scholar were carried out from inception to October 2022 to identify observational studies conducted among adult liver transplant recipients which measured depression, anxiety, and/or insomnia. We used the Joanna-Briggs tool for study quality appraisal. RESULTS: Sixty-five studies (pooled N = 12,183) provided data for meta-analysis. The one-year pooled point prevalence rate for depressive symptoms was 25% (95% Confidence Intervals [CI]: 20% to 30%; I2 = 94%; 37 studies; N = 6088) while that of anxiety and insomnia symptoms were 29% (95% CI: 21% to 38%; I2 = 96%; 28 studies; N = 4016) and 28% (95% CI: 16% to 43%; I2 = 98%; 14 studies; N = 1834), respectively. The findings remained robust across subgroup and sensitivity analyses. Most included studies had low or moderate risk of bias. CONCLUSIONS: Depressive, anxiety, and insomnia symptoms are commonly prevalent following liver transplantation. Our findings, though limited by high heterogeneity across analyses, have important implications for screening, management, and prevention of psychological morbidity in this group. SYSTEMATIC REVIEW REGISTRATION: This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42021276008).

The pattern of inpatient psychiatry admissions at a general hospital psychiatry unit in South India: A retrospective study.

Background: Mental illnesses are becoming a major health issue across the world. The availability of inpatient facilities for mentally ill patients is very much limited in developing countries such as India. Aim: This study was aimed to explore the pattern of psychiatric admissions at a general hospital psychiatry unit (GHPU) in South India. Methodology: The study was conducted at a multispecialty tertiary care hospital in South India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the department of psychiatry, the medical records department, and the electronic hospital information system of the institute were reviewed between April 2006 and March 2016. Results: A total of 3082 patients were admitted as psychiatry inpatients during the 10-year study period, representing an average of 308.2 admissions per calendar year. The majority of inpatients were male (n = 1824; 59.2%). Concerning diagnostic categories, mood disorders were accounted for 33.6% of admissions, followed by psychotic disorders (26.4%) and substance use disorders (19.3%), respectively. The median length of hospital stay was 14 days (range 0-163 days). A statistically significant seasonality pattern was noticed for mood disorders (December to February) and anxiety and neurotic disorders (August to October). Conclusion: It is obvious that treatment-seeking attitude among individuals with mental illnesses is increasing and the awareness regarding treatment aspects is also increasing among the general public. Hence, there is a need to improve the existing resources to facilitate intensive management for better treatment outcomes and this, in turn, will enhance the quality of life of mentally ill individuals.

Fate of Manuscripts Rejected by a Specialty Psychiatry Journal: A Retrospective Cohort Study.

Background: Little is known about the publication outcomes of submissions rejected by specialty psychiatry journals. We aimed to investigate the publication fate of original research manuscripts previously rejected by the Indian Journal of Psychological Medicine (IJPM). Methods: A random sampling of manuscripts was drawn from all submissions rejected between January 1, 2018, and December 31, 2019. Using the titles of these papers and the author names, a systematic search of electronic databases was carried out to examine if these manuscripts have been published elsewhere or not. We extracted data on a range of scientific and nonscientific parameters from the journal's manuscript management portal for every rejected manuscript. Multivariable analysis was used to detect factors associated with eventual publication. Results: Out of 302 manuscripts analyzed, 139 (46.0%) were published elsewhere; of these, only 18 articles (13.0%) were published in a journal with higher standing than IJPM. Manuscripts of foreign origin (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.06-2.97) and rejection following peer review or editorial re-review (OR 2.41, 95% CI = 1.22-4.74) were significantly associated with publication. Conclusion: Nearly half of the papers rejected by IJPM were eventually published in other journals, though such papers are more often published in journals with lower standing. Manuscripts rejected following peer review were more likely to reach full publication status compared to those which were desk rejected.

Trust but verify: An analysis of redundant publications from two major psychiatry journals in India.

Background: No analysis of redundant or duplicate publications, deemed unethical and unscientific, has been undertaken in psychiatric literature. Aim: To analyze the proportion and patterns of redundant publications associated with index articles published in two major Indian psychiatry journals. Methods: Index articles were original papers published in the Indian Journal of Psychiatry and the Indian Journal of Psychological Medicine between 2015 and 2017. Using a systematic search strategy that combined author names and article keywords, we combed the literature to identify and characterize redundant publications related to these index articles. Redundant publications were classified into one of the following categories using a priori definitions: dual, suspected dual, salami slicing, meat extender, and extended sample publication. Results: From 324 index articles screened, a total of 27 articles (8.4%) were identified to have 32 associated redundant publications of the following types: dual (n = 3), suspected dual (n = 2), salami slicing (n = 22), meat extender (n = 3), and extended sample publication (n = 2). A majority of the redundant articles (n = 23, 71.9%) failed to clearly cross-reference the prior publication(s). We also identified nine non-redundant but related publications with no proper cross-referencing in five of them. Conclusion: Redundant publications are a common practice in the psychiatry journals screened. Salami slicing is the most common form of redundancy, with no proper cross-referencing in most cases. Concerted efforts are needed to detect and deal with this concerning practice that undermines both science and ethics.

Psychological Autopsy Studies of Suicide in South East Asia.

Background: Psychiatric disorders have been identified as an important risk factor for suicide. However, different psychological autopsy studies have revealed different prevalences at different times and places. Objective: We aimed to see the distribution of psychological autopsy studies and the prevalence of mental disorders among suicides and identify major risk factors in Southeast Asian countries. Method: We scrutinized psychological autopsy studies published in the World Health Organization (WHO) South-East Asia (SEA) region countries. We also searched the available bibliographies to identify the studies in the region so that all the possible articles could be included. Results: Out of the 11 countries, 14 psychological autopsy studies were identified in five SEA countries (Bangladesh [1], India [9], Indonesia [1], Nepal [1], and Sri Lanka [2]). Seven studies (50%) used a case-control study design, and eight (57.1%) were carried out in urban settings. The prevalence of psychiatric disorders in case-control studies was from 37% to 88%. Stressful life event was identified as a major risk factor in all the case-control studies. Conclusion: Psychological autopsy studies have not been conducted in 6 out of 11 countries of the SEA region. The presence of pre-existing psychiatric morbidity and stressful life events were the two most common risk factors noted across settings, even though there is wide heterogeneity in samples, study design, instruments, and study settings.

Why Do Manuscripts Get Rejected? A Content Analysis of Rejection Reports from the Indian Journal of Psychological Medicine.

Background: A proportion of manuscripts submitted to scientific journals get rejected, for varied reasons. A systematic analysis of the reasons for rejection will be relevant to editors, reviewers, and prospective authors. We aimed to analyze the reasons for rejection of manuscripts submitted to the Indian Journal of Psychological Medicine, the flagship journal of Indian Psychiatric Society South Zonal Branch. Methods: We performed a content analysis of the rejection reports of all the articles submitted to the journal between January 1, 2018, and May 15, 2020. Rejection reports were extracted from the manuscript management website and divided into three types: desk rejections, post-peer-review rejections, and post-editorial-re-review rejections. They were analyzed separately for the rejection reasons, using a predefined coding frame. Results: A total of 898 rejection reports were available for content analysis. Rejection was a common fate for manuscripts across the types of submission; figures ranged from 26.7% for viewpoint articles to 72.1% for review articles. The median time to desk rejection was 3 days, while the median time to post-peer-review rejection and post-editorial-re-review rejection was 42 days and 96 days, respectively. The most common reasons for desk rejection were lack of novelty or being out of the journal's scope. Inappropriate study designs, poor methodological descriptions, poor quality of writing, and weak study rationale were the most common rejection reasons mentioned by both peer reviewers and editorial re-reviewers. Conclusions: Common reasons for rejection included poor methodology and poorly written manuscripts. Prospective authors should pay adequate attention to conceptualization, design, and presentation of their study, apart from selecting an appropriate journal, to avoid rejection and enhance their manuscript's chances of publication.

Trends in female authorship in two major psychiatry journals in India.

Women authors are under-represented in academic medicine and academic publishing. We examined the representation of women in key authorship positions in psychiatric journals in India as well as time trends in female authorship across a decade. All articles originating from India and published in two leading Indian psychiatry journals during 2019-2020 were examined and compared with articles published in these journals during 2009-2010. Important outcomes examined were representations of women as first author, corresponding author, and last author, and the number of women in authorship lists. A total of 817 articles was analyzed; of these, 251 (30.7%) were published during 2009-2010 and 566 (69.3%) during 2019-2020. Women first-authored just over a quarter of the articles (n = 218, 26.7%). Nearly half of the articles (n = 389, 47.6%) had no woman author. Representation of women in key authorship positions and in total authorship increased significantly across time. Notably, the proportion of women first authors significantly increased for original papers (24.5% in 2009-2010 vs 38.1% in 2019-2020, p = 0.011). Gender gap in academic psychiatry publishing in India has narrowed during the past decade but is still evident. There is a need to identify and address factors that could narrow the gender gap.

Quality of media reporting following a celebrity suicide in India.

BACKGROUND: Celebrity suicides have the potential to trigger suicide contagion, particularly when media reporting is detailed and imbalanced. We aimed to assess the quality of media reporting of suicide of a popular Indian entertainment celebrity against the World Health Organization (WHO) suicide reporting guidelines. METHODS: Relevant news articles that reported the actor's suicide were retrieved from online news portals of regional and English language newspapers and television channels in the immediate week following the event. Deductive content analysis of these articles was done using a pre-designed data extraction form. RESULTS: A total of 573 news articles were analyzed. Several breaches of reporting were noted in relation to mentioning the word 'celebrity' in the title of report (14.7%), inclusion of the deceased's photograph (88.5%), detailed descriptions of the method (50.4%) and location of suicide (70.6%); local language newspapers were more culpable than English newspapers. Helpful reporting characteristics such as mentioning warning signs (4.1%), including educational information (2.7%) and suicide support line details (14.0%) were rarely practiced. CONCLUSION: Media reporting of celebrity suicide in India is imbalanced and poorly adherent to suicide reporting recommendations. Local language news reports display more frequent and serious violations in reporting as opposed to English news articles.

Changing trends in quality of media reporting of suicide in the community following a celebrity suicide in India.

OBJECTIVE: Little is known about changes in quality of media reporting of suicide in the community following a celebrity suicide. Our objective was to compare trends in quality of media reporting of suicide, before and after the suicide of an Indian entertainment celebrity, against the World Health Organization suicide reporting guidelines. METHOD: Online news portals of English and local language newspapers, as well as television channels, were searched to identify relevant suicide-related news articles. Comparison of reporting characteristics before and after the celebrity suicide was performed using chi-square test or Fisher's exact test. RESULTS: A total of 3867 eligible news reports were retrieved. There was a significant increase in harmful reporting characteristics, such as reporting the name, age and gender of the deceased (p < 0.001 for all comparisons), mentioning the location (p < 0.001) and reason for suicide (p = 0.04) and including photos of the deceased (p = 0.002) following the celebrity suicide. Helpful reporting practices were less affected; there was a significant rise in inclusion of expert opinion (p = 0.04) and mention of suicide-related warning signs (p = 0.02). CONCLUSION: Following a celebrity suicide, significant changes in the quality of media reporting of suicide were noted with an increase in several potentially harmful reporting characteristics.