Potential clinical applications of Ashwagandha (Withania somnifera) in medicine and neuropsychiatry.

INTRODUCTION: Ashwagandha (ASW) is the extract of the plant Withania somnifera. It is widely used in complementary, alternative, and integrative medicine (CAIM) but is little discussed in mainstream modern medical literature. AREAS COVERED: We performed a review of potential pharmacotherapeutic properties of ASW. Studies were sourced from relevant online and offline databases. In animal models, ASW displays antioxidant activity. It has GABAergic and other neurotransmitter modulatory effects. It reduces apoptosis and promotes synaptic plasticity. It improves cognition and reverses induced cognitive deficits. It attenuates indices of stress. In human subjects, ASW enhances adaptogenesis in healthy adults. It modestly benefits generalized anxiety disorder and obsessive-compulsive disorder, and symptom severity in schizophrenia, substance use disorders, and attention deficit hyperactivity disorder. It improves sleep quality. EXPERT OPINION: ASW may confer modest benefit in certain neuropsychiatric conditions. Its benefits may arise from induction of neuroplasticity, antioxidant and anti-inflammatory effects, and modulation of GABA and glutamate, as well as other neurotransmitters. The antioxidant and anti-inflammatory actions may also benefit neurodegenerative states. Reports of clinical benefit with ASW must be interpreted with caution, given the paucity of randomized clinical trials (RCTs). Greater methodological rigor is necessary before clinical recommendations on ASW can be confidently made.

ASW is an extract of the Indian winter review and meta-analysis of four RCTs reported scientific studies on the use of ASW in animal and human subjects in order to identify potential clinical uses in modern medicine.Our review finds that ASW has antioxidant and anti-inflammatory action. It also modulates the effects of several neurotransmitters in the brain. It attenuates laboratory and clinical indices of stress. These mechanisms may benefit mental illnesses such as anxiety, depression, obsessive-compulsive disorder, schizophrenia, attention deficit hyperactivity disorder, and addictive disorders. ASW improves exercise capacity in healthy adults. It also appears to improve sleep quality. In addition, ASW may also improve cognitive functioning post-brain injury and in those at risk of dementia. There is evidence from animal models that ASW may also be of benefit in cancer, stroke, and induced organ damage.These studies, while suggesting a wide range of potential clinical applications for ASW, must be viewed with caution because the clinical data are based on small numbers of patients treated for a relatively short period of time. Many clinical trials that found benefits with ASW were one-off studies that have not been replicated. Larger and more methodologically stringent clinical trials are required before ASW can be confidently recommended for clinical use. Because ASW is a herbal extract and because the efficacy of its many constituents is not known, it is not possible to generalize conclusions to all extracts, whether standardized or not.

Sociodemographic and cultural determinants of mood disorders.

PURPOSE OF REVIEW: The present review aims to examine, summarize and update information on the sociodemographic and cultural determinants of mood disorders. RECENT FINDINGS: Known sociodemographic and cultural determinants continue to be good predictors of the risk of developing a mood disorder over the lifetime. Polygenic risk scores do not appear to offer any advantages over these determinants at present. There is also new and emerging understanding of the role of lifestyle and environmental factors in mediating vulnerability to mood disorder. The influence of ethnicity and migration, on the other hand, is far more complex than initially envisaged. SUMMARY: Recent evidence on sociodemographic determinants of mood disorders confirms associations derived from existing literature. There is also new and emerging evidence on how quality of sleep, diet and the environment influence risk of mood disorders. Culture and ethnicity, depending on context, may contribute to both vulnerability and resilience. Socioeconomic deprivation may be the final common pathway through which several sociodemographic and cultural determinants of mood disorders act.

Does Alice Live Here Anymore? Autonomy and Identity in Persons Living and Dying With Dementia.

Conventional scientific definitions of dementia, or its newer proposed alternate-neurocognitive disorders place emphasis upon cognitive function, particularly memory. The changes in thought, emotion, behavior, personality, and biological function are usually considered only of secondary importance. At the core of the illness, however, lies a progressive loss of self, and by extension, of personhood, identity, autonomy, and agency. The identity of the person living with dementia, and the deterioration of a sense of self assumes significance in planning end of life care, including palliative care. A consideration of self and identity is also significant where physician assisted death, incorporating euthanasia, has legal sanctity. As dementia progresses, there is usually a progressive loss of personal decision making capacity and legal competence. Shared decision making, advance care directives and proxy representatives are options available to safeguard autonomy and agency in such cases. Advance care directives are often treated as static documents. The loss of self and deterioration of identity in persons with dementia means, that there is a psychological discontinuity across time and space, though biological continuity is retained. The discontinuity in self and identity however, imply that the person with dementia changes considerably and so too may values and beliefs. A document which best reflected the wishes of the person with dementia in the past, may not always do so now. Advance directives and proxy representatives may need to be dynamic and evolve over time, particularly where end of life care and physician assisted death is being invoked.

Barriers to Impact Factor Growth in Two Major Psychiatry Journals in India.

BACKGROUND: Despite exponential growth in Indian research, Indian journals have low impact factors. A previous study by one of the authors (CA) of this paper showed that articles published in the Indian Journal of Psychiatry (IJP) under-referenced previously published relevant papers in the same journal. Based on this, we decided to investigate the citation characteristics of contemporary scientific articles published in the Indian Journal of Psychological Medicine (IJPM). METHODS: The citation characteristics of scientific articles published in 2018 (Vol 40, issues 1-6) in the IJPM were examined to determine how well the authors cited relevant articles published during the past ten years in the IJPM and the IJP. RESULTS: There were 145 and 142 citation-worthy articles in the IJPM and the IJP, respectively; of these, 85.5% and 65.5%, respectively, had not been cited. CONCLUSIONS: Authors publishing in the IJPM under-reference previous relevant research published in the IJPM and IJP. This suggests unawareness of, deliberate disregard of, or even disdain for prior Indian research in the field. Additionally, if Indian researchers do not cite previous Indian research in the field published in Indian journals, the citation metrics of Indian journals will not grow.

Caring for Persons Living With Dementia During the COVID-19 Pandemic: Advocacy Perspectives From India.

The Coronavirus disease 2019 (COVID-19) pandemic has presented an unprecedented threat to global public and psychosocial health. Certain vulnerable populations, especially the older adults, are at disproportionate risks both to the physiological and social effects of the outbreak. A special section among them who face unique challenges during this pandemic, are those living with neurocognitive disorders, like dementia. Limited research in the field shows ApoE4 allele to confer an increased risk for COVID-19 severity, while the behavioral problems associated with dementia reduces compliance to precautionary measures, thereby exposing them to the virus and increasing caregiver strain. Reduced healthcare access, limited resources and fear of the infection act as major barriers to dementia care during such a crisis. Besides, there are the additional burden of stigma, abuse, ageism and financial impoverishment. Institutionalization, loneliness and lack of stimulation can potentially accelerate the cognitive decline and worsen the behavioral and psychological problems. India has been one of the worst hit countries by COVID-19 and shares a significant dementia load. As the country is aging fast along with the world, this commentary reviews the risks of people living with dementia during the pandemic and discusses certain advocacies for their care.

'An invisible human rights crisis': The marginalization of older adults during the COVID-19 pandemic - An advocacy review.

The world has endured over six months of the Coronavirus disease 2019 (COVID-19). Older adults are at disproportionate risk of severe infection and mortality. They are also vulnerable to loneliness and social exclusion during the pandemic. Age and ageism both can act as significant risk factors during this pandemic, increasing the physical as well as psychosocial burden on the elderly. A review was performed in relation to the psychosocial vulnerabilities of the older adults during the pandemic, with insights from the similar biological disasters in the past. Besides the physiological risk, morbidities, polypharmacy and increased case fatality rates, various social factors like lack of security, loneliness, isolation, ageism, sexism, dependency, stigma, abuse and restriction to health care access were identified as crucial in pandemic situation. Frailty, cognitive and sensory impairments added to the burden. Marginalization and human rights deprivation emerged as a common pathway of suffering for the elderly during COVID-19. The implications of the emergent themes are discussed in light of psychosocial wellbeing and impact on the quality of life. The authors suggest potential recommendations to mitigate this marginalization on lines of the World Health Organization (WHO)'s concept of Healthy Ageing and the United Nations (U.N.) Sustainable Development Goals.

The ICMR bulletin on targeted hydroxychloroquine prophylaxis for Covid-19: Need to interpret with caution.

The National Task Force for Covid-19 of the Indian Council of Medical Research (ICMR) in a bulletin dated March 21, 2020 recommended the use of hydroxychloroquine for prophylaxis in asymptomatic health care workers caring for suspected or confirmed patients and household contacts of confirmed patients. This is cause for concern with regard to bioethics and good clinical practice. The evidence for the efficacy of chloroquine and hydroxychloroquine is currently derived from open label trials and cell culture studies with no conclusive evidence available from randomised clinical trials. Hydroxychloroquine also carries contraindications in the case of conditions such as maculopathy, retinopathy and QTc prolongation and should be used with caution in vulnerable populations such as children, pregnancy, lactation and the elderly. Despite this, there has been a rush to procure and self-medicate with hydroxychloroquine, which has been addressed by the National Task Force. The WHO and the FDA have not found adequate evidence to recommend any specific medication for the treatment of Covid-19. While further evidence is awaited, including from trials registered with the FDA and the ICMR, it is recommended that the administration of hydroxychloroquine for chemo-prophylaxis be considered on a case by case basis with monitoring by a registered medical practitioner including electrocardiography (ECG). The potential for retinal and cardiac toxicity must also be borne in mind. It is further recommended that a public advisory regarding the need for caution in chemo-prophylaxis be made available in the public domain. Keywords: Coronavirus, Covid-19, SARS-CoV-2, hydroxychloroquine, chloroquine, chemoprophylaxis, bioethics, evidence- based medicine.