Somatic symptoms in schizophrenia: Association with socio-demographic and clinical characteristics, disability and quality of life.

Background and Aims: There is lack of research on somatic symptoms in schizophrenia. We aimed at finding prevalence and types of somatic symptoms in patients with schizophrenia and assessed their association with socio-demographic and clinical characteristics. Methods: We assessed somatic symptoms using Patient Health Questionnaire-15 (PHQ-15) in 93 patients with schizophrenia diagnosed on ICD10-DCR. Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms, WHO Disability Assessment Schedule 2.0, WHO Quality of Life (BREF) Hindi version and Liverpool University Neuroleptic Side-Effect Rating Scale were used to assess psychopathology, disability, quality of life and side effects. Results: Significant somatic symptoms (n ≥5 on PHQ-15) were present in 62 (67.7%) patients with schizophrenia. Forty three (69.4%) had mild (n = 5-9 on PHQ-15), 17 (27.4%) had moderate (n = 10-14 on PHQ-15), and only 2 (3.2%) had severe (n = ≥15 on PHQ -15) somatic symptoms. Mean somatic symptoms score on PHQ-15 was 7.28 (± 3.83); 96.8% reported feeling tired, 76.3% had constipation or diarrhoea, 67.7% trouble in sleeping, 61.3% nausea or indigestion, 52.7% back pain and 51.6% headache. Patients with somatic symptoms were older in age, had longer duration of illness and treatment, and had more negative symptoms. They had higher disability and poor quality of life especially in physical domain. Conclusion: Somatic symptoms are common in patients with schizophrenia and are associated with chronicity, refractoriness and negative symptoms, significant disability and poor quality of life. Thus during routine clinical practice, somatic symptoms should be assessed and managed in these patients.

Disability and quality of life in patients with treatment-resistant schizophrenia on long- term clozapine therapy.

Objectives: To assess disability and quality of life (QOL) in treatment resistant schizophrenia (TRS) on long term clozapine therapy and assess their correlation with positive, negative and cognitive symptoms. Methodology: Disability and QOL in forty patients with TRS (as per modified Kane's criteria) were assessed using World Health Organization Disability Assessment Schedule 2.0 and World Health Organization Quality of Life-BREF. Scale for assessment of positive symptoms, scale for assessment of negative symptoms and Addenbrooke's cognitive examination-III were used to assess positive, negative and cognitive symptoms. Medication adherence rating scale assessed medication adherence. Results: Disability and QOL correlated significantly with medication adherence, negative and cognitive symptoms but not with positive symptoms. Subgroup analysis revealed significant difference between medication adherence (good vs poor) and cognitive (impairment vs non-impairment) groups. Conclusion: Negative and cognitive symptoms, and medication adherence correlated with disability and QOL.

Cognitive impairment in opioid use disorders: Is there a case for use of nootropics?

Opioid Use Disorders (OUDs) are often associated with cognitive impairments, which may lead to an increased risk of relapse. These cognitive deficits do not resolve with abstinence or medication-assisted treatment and may require targeted management. While psychotherapies and neuromodulation techniques have been studied for their effectiveness, they have certain limitations and challenges. Cognition enhancing prescription drugs like donepezil and memantine, which are used in dementias, have shown promise in a small number of studies examining their role in the reversal of opioid-induced cognitive deficits. The authors explore the potential role of nootropics in improvement of cognitive decline associated with OUDs.

A comparative study of sexual behavior, dysfunction, satisfaction, relationship, and sexual quality of life amongst treatment-naïve and abstinent men (buprenorphine-maintained) with Opioid (heroin) dependence syndrome.

Background: Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking. Aim: To compare sexual behavior, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients (GROUP-I) with Opioid (heroin) dependence syndrome (ODS-H) with those maintained on buprenorphine (GROUP-II). Methods: Married adult males diagnosed with ODS-H, currently sexually active, and living with their partner were recruited. They were assessed for their sexual practices and high-risk sexual behavior (HRSB) through a semi-structured questionnaire and sexual functioning, relationships, satisfaction, and sQoL through structured questionnaires. Results: A total of 112 individuals (GROUP-I: 63; GROUP-II: 49) were recruited from the outpatient settings. Mean age and employment in GROUP-II were higher (p < 0.05) than in GROUP-I (37 vs 32 years; 94% vs 70%, respectively). Other sociodemographic variables and the age of onset of heroin use were comparable. The current practice of HRSB (e.g., engaging in casual partner sex, sex with commercial sex workers, and sex under intoxication) was higher in GROUP-I while almost no differences were seen in lifetime HRSB. The frequency of erectile dysfunction and premature ejaculation in the two groups were: 78% vs 39% (p < 0.001), and 30% vs 6% (p = 0.001), respectively. GROUP-II had significantly higher scores in all the scales (p < 0.05) as compared to GROUP-I, indicating better sexual satisfaction, quality of life, and sexual relationship. Conclusion: Heroin use is associated with HRSB, poorer sexual functioning, overall satisfaction, and sQoL. Maintenance of Buprenorphine helps with improvement in all these parameters. Comprehensive management for substance use should target sexual problems as well.

Proton magnetic resonance spectroscopy-based evaluation of metabolic abnormalities in the right dorsolateral prefrontal cortex and caudate nucleus in treatment-naïve patients with obsessive-compulsive disorder.

Background: Obsessive-compulsive disorder (OCD) is a common psychiatric disorder whose underlying pathophysiology is insufficiently understood. The pathophysiology of OCD may be related to abnormalities in the biochemistry of neurotransmitters. Aim: The aim of the present study was to measure the absolute concentration of various metabolites in the right dorsolateral prefrontal cortex (DLPFC) and caudate nucleus (CN) in treatment-naive patients with OCD and compare it with healthy controls (HCs). Methods: The present study investigated the metabolic profile of two brain regions, namely right DLPFC and CN, by using single voxel in-vivo proton magnetic resonance spectroscopy (1H MRS) in drug-naive patients with OCD (n = 17, mean age = 30.71 ± 10.104 years) and compared it with healthy controls (n = 13, mean age = 30.77 ± 5.449 years). The patients with OCD were recruited after appropriate psychometric assessments. The 1H-MRS experiments were performed using the 3 Tesla (3T) human MR scanner, and absolute concentrations of metabolites were estimated using the LC model. Results: Significantly lower concentration of tNAA in the right DLPFC was observed in the patients with OCD compared to the controls, which may be indicative of neurodegeneration in this region. However, no significant differences were observed in the concentrations of the metabolites between the patients and controls in the CN region. The level of tNAA in DLPFC significantly correlated with the disability level (WHO-DAS) of the patients. Conclusions: The present study demonstrates abnormalities in the metabolic profile of an important region, DLPFC of the CSTC circuit, which is suggestive of neurodegeneration in the region in OCD patients.

Digital Capacity and Interest in mHealth Interventions Among Individuals on Opioid Agonist Maintenance Treatment: A Cross-Sectional Community-Based Study.

Background: Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods: 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results: 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions: In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions.

Is it a challenging task to work with personal protective equipment in a COVID-19 ICU: Findings from a hospital-based cross-sectional study from north India.

Introduction: Amidst the coronavirus disease 2019 (COVID-19) pandemic, the use of personal protective equipment (PPE) is mandatory for healthcare workers to remain protected against infection. The present study was undertaken to evaluate challenges faced by the healthcare workers while using level 3 PPE. Methods: This hospital-based study was conducted among resident doctors selected by convenience sampling method using a pretested, semi-structured, self-administered questionnaire after getting informed consent from the participants to collect data on the somatic, psychological, and technical problems faced while working in PPE. Bivariate and multivariable logistic regression was done between outcome variables and other independent variables to check for the association. Results: Of the total, 252 resident doctors completed the survey, their age ranged from 22 to 36 years with 140 (55.6%) males and 112 (44.4%) females. One-twenty-nine (51.2%) residents were trained to work in ICU, 73 (29%) participants used PPE ≤10 times and the rest 179 (71%) used PPE more than 10 times. The difficulties faced were as follows: visual impairment (n = 244, 96.8%), headache (n = 226, 89.6%), breathing difficulty (n = 216, 85.7%), hearing impairment (n = 201, 79.8%), sweating (n = 242, 96%), and fear of being infected (n = 156,61.9%). Two-thirty-six (93.6%) participants felt that overall work quality reduced due to PPE. Headache, hunger, urge to micturate, anxiety, sleep disturbances, and need to change the timing of medication or diet were higher with increased duration of work with PPE. Conclusion: A longer duration of work is associated with headache, hunger, anxiety, and sleep disturbances. More research has to be done to improve the PPE to reduce problems like visual impairment, skin irritation, sweating, and breathing difficulty.

Learning from telepsychiatry during COVID-19 pandemic in India: Boon for public mental health in low- & middle-income countries.

Novel coronavirus disease (COVID-19) pandemic has affected the mental well-being of the population and posed many challenges in availing mental healthcare. Telepsychiatry has been proven to be an effective route for the delivery of mental healthcare. We share our experience of using the telemedicine approach in providing mental health services at a tertiarycare hospital in India during the COVID-19 pandemic, following the break in routine outpatient services during the national lockdown. The telepsychiatry approach helped in ensuring the maintenance of mental healthcare. The utility of telepsychiatry as an option for such future situations and for its use in routine follow up care in indicated cases, have also been discussed.

Impact of 1918 influenza pandemic on mental asylums in India: An analysis of asylum reports.

Introduction: Not much is known about impact of 1918 Influenza on patients confined inside mental asylums of that period. Aim and Methods: The study aimed to assess impact of Influenza pandemic on mentally ill patients in asylums, based on data extracted from provincial asylum reports (1915-1923) from British India. Results: The asylum population in most provinces was impacted both in terms of direct mortality (1918) as well as all-cause morbidity and mortality (1918; 1918-1920). Agra and Oudh lost 9.5% of average daily asylum strength directly due to influenza in 1918. All-cause mortality (1918) was highest for mental asylum/s in provinces of Agra and Oudh (16.83%), Punjab (14.83%), and Bombay (14.4%). Isolated outbreaks continued till 1923. Another peculiar finding was markedly reduced sickness and death rates in 1921-1923 compared to 1915-1917, across asylums of all provinces. Conclusion: Findings point to a significant impact of Influenza pandemic in mental asylums across several provinces, and provide historical insights with implications for the current pandemic.

Technology and Medical Care in India: Growth of Telehealth Awareness during the COVID-19 Pandemic.

BACKGROUND: COVID-19 pandemic has highlighted the importance of telemedicine in health care delivery worldwide. However, the true success of telemedicine depends on patients' acceptance, which in turn is decided by their interest in telemedicine. In this study, we aim to assess the population interest in telemedicine services across India during the COVID-19 pandemic. METHODS: We measured national-level public interest in "telemedicine" using terms related to telemedicine in Google Trends during the years 2019 and 2020. The relationship between population search volume for telemedicine (composite score) and the number of COVID-19 cases during the early phase of COVID-19 was analyzed. The literacy rate and relative interest in telemedicine in the states were analyzed to assess the impact of education on telemedicine interest. RESULTS: The interest in telemedicine in the year 2020 is higher compared to the year 2019 (U = 269.5, z = -7.043, p<0.001). The search trends for telemedicine increased consistently during the early phase of the COVID-19 pandemic. The greatest search volume was seen in Andhra Pradesh. There was a strong correlation (r = 0.65, p < 0.001) between the initial increase in the number of COVID-19 cases and population-level interest in telemedicine over time. The relative interest in telemedicine for the year 2019 showed a significant direct relationship with the literacy rate (r = 0.47, p = 0.04). However, the relative interest in telemedicine for the year 2020 showed no relationship with the state's literacy rate signifying the spread of telemedicine across literacy barriers. CONCLUSION: Population interest in telemedicine was higher in the year 2020 compared to the previous year and remained high even after the easing of lockdown. The COVID-19 pandemic has played an important role in increasing the Indian public's interest in telemedicine.

Treatment Needs and Service Delivery for Patients with Dual Disorders During the COVID-19 Pandemic: Findings From the WADD Survey.

OBJECTIVE: The COVID-19 pandemic has posed a great challenge for the existing health systems. The restrictions imposed across countries on the movement of people and the realignment of health care services in response to the pandemic are likely to negatively affect the health status and delivery of mental health services to persons with dual disorders (PWDD). Methods: An online survey was conducted among mental health professionals involved in providing care to PWDD to better understand the problems encountered and identify potential solutions in providing continued treatment for PWDD during the COVID-19 pandemic. Results: The findings confirmed significant disruption in the delivery of treatment services for PWDD during the COVID-19 pandemic. Dissatisfaction with personal protective equipment, inadequate COVID-19 testing services at treatment facility, and lack of guidelines on providing continued treatment services to PWDD by national authorities or professional bodies were identified as the likely reasons for this disruption. Conclusions: These concerns in turn need to be addressed by the policy-makers, hospital management staff, and other stakeholders. Specifically, there should be a focus on developing and disseminating guidelines to assist mental health professionals in setting-up and providing continued treatment services to PWDD via tele-psychiatry and other novel digital strategies.

Sexual relationship, self-esteem, dysfunction, and sexual satisfaction in treatment naïve men with heroin dependence.

Heroin use, a prevalent and disabling condition, affects sexual functioning and the sexual quality of life. While there is adequate literature on sexual dysfunction with heroin use, the literature is scarce on the emotional aspects of sex, like the perception of sexual relationship, self-esteem, and satisfaction amongst heroin users. The study assessed these parameters among treatment-naïve, sexually active, married, male patients with heroin dependence. We interviewed 63 treatment-naïve men seeking treatment for heroin dependence using Self-esteem and Relationship Questionnaire (SEAR), New Sexual Satisfaction Scale-Short form (NSSS-S), Sexual Quality of Life Questionnaire-Male (SQoL-M), Index of Premature Ejaculation (IPE), and International Index of Erectile Function (IIEF). Overall scores in SEAR, NSSS-S, SQoL-M, IIEF, and IPE were low, suggesting poor self-esteem and relationship, poor sexual quality of life and sexual satisfaction, higher premature ejaculation, and erectile dysfunction. Injecting drug use was associated with lower scores on confidence domain of SEAR, partner activity focused domain of NSSS-S, intercourse-satisfaction, and overall sexual quality of life. Sexual dysfunctions, poor sexual relationship, and sexual quality of life are common among men seeking treatment for heroin dependence. Treatment strategies must not lose focus on this dimension of health during the treatment process.

Top 100 cited articles in one year of COVID-19 research - A bibliometric analysis.

BACKGROUND: Coronavirus disease (COVID-19)-related scientific publications have increased exponentially during the present pandemic but their influence on biomedical literature is not known. The characteristics of highly cited articles help us to identify important advances and their scientific impact. OBJECTIVES: In the present study, we have identified and analyzed the top 100 most highly-cited articles of COVID-19 research published in the year 2020. METHODS: A cross-sectional bibliometric analysis was using the search terms "severe acute respiratory syndrome-coronavirus-2," "COVID," "nCoV," "Coronavirus," and "HCoV" querying the Google Scholar database using the program "Publish or Perish." The first 100 English language articles with the maximum number of citations were identified and evaluated in detail. RESULTS: The top 100 COVID-19 articles in 2020 had citations ranging from 1147 to 20,440. The median (interquartile range [IQR]) number of citations was 1970 (1456-2939). The number of authors ranged from 1 to 79 (median 10; IQR 5.25-19). The majority of first authors was from China (58%), followed by the United States of America (16%) and the United Kingdom (7%). The top three journals in terms of the number of published articles (37%) were the New England Journal of Medicine, Journal of the American Medical Association, and The Lancet. Most of the top-cited COVID-19 literature were descriptive studies focusing on epidemiology (48%) and clinical course (60%) of COVID-19. CONCLUSION: Clinical course and epidemiology have been the predominant areas of research interest in COVID-19 in 2020. Citation analysis of COVID-19 literature helps us to map out the most important focus for research in this pandemic and to identify gaps in knowledge which would guide further research.

Screen Time beyond Gaming and Social Media: Excessive and Problematic Use of Over the Top (OTT) Platforms among College Students during COVID-19 Pandemic.

There is a gap in existing literature regarding Over the Top (OTT) platform use contributing to the excessive and problematic screen time. We aimed to assess OTT platform use among college students and its associations with increased screen time, mental well-being, COVID-19 related anxiety and personality traits. A total of 1039 students from a college in India were invited to participate in this web-based survey. A majority of participants used OTT platforms regularly. Subscription to paid OTT platforms, poor mental well-being were associated with problematic OTT use; whereas personality trait of conscientiousness seemed to offer protection against problematic OTT use.

The quality of online media reporting of celebrity suicide in India and its association with subsequent online suicide-related search behaviour among general population: An infodemiology study.

The literature reports increased suicide rates among general population in the weeks following the celebrity suicide, known as the Werther effect. The World Health Organization (WHO) has developed guidelines for responsible media reporting of suicide. The present study aimed to assess the quality of online media reporting of a recent celebrity suicide in India and its impact on the online suicide related search behaviour of the population. A total of 200 online media reports about Sushant Singh Rajput's suicide published between 14th to 20th June 2020 were assessed for quality of reporting following the checklist prepared using the WHO guidelines. Further, we examined the change in online suicide-seeking and help-seeking search behaviour of the population following celebrity suicide for the month of June using selected keywords. In terms of potentially harmful media reportage, 85.5 % of online reports violated at least one WHO media reporting guideline. In terms of potentially helpful media reportage, only 13 % articles provided information about where to seek help for suicidal thoughts or ideation. There was a significant increase in online suicide-seeking (U = 0.5, p < 0.05) and help-seeking (U = 6.5, p < 0.05) behaviour after the reference event, when compared to baseline. However, the online peak search interest for suicide-seeking was greater than help-seeking. This provides support for a strong Werther effect, possibly associated with poor quality of media reporting of celebrity suicide. There is an urgent need for taking steps to improve the quality of media reporting of suicide in India.

The top 100 cited articles on Obsessive Compulsive Disorder (OCD): A citation analysis.

There is an exponential growth in the field of biomedical literature over the years. Although numerous articles are published every year, few of them present important conceptual advances in that particular field and are found to be influential in the evolution of the field. The number of citations a publication receives can be used as a proxy marker of its impact on the field. Hence we aimed to analyze the top cited articles (n = 100) on obsessive compulsive disorder (OCD) as of July 2018. Google scholar database was searched using a freely available software, Publish or Perish. Information related to number of citations, publication title, publication year, name of the journal, country of origin, author details, institution of origin, article type, and article design. The original research articles were further classified into descriptive/epidemiology, mechanism, management, scale/measurement, imaging and medical psychiatry. The citation classics suggest that clinical trials/management, epidemiology and neuroimaging were the most researched areas in the OCD research. These citation classics provide an important insight into the historical developments, like the role of serotonin and caudate in OCD. This approach of citation analysis provides an opportunity to retrieve the classic articles on OCD, and describes the trends in OCD research.