Background Tobacco is prevalently used in smoking or smokeless forms and remains a major public health concern worldwide, with its adverse effects on overall health. Omega-3 fatty acid (FA) has shown its promising effects in various health conditions. Objective The purpose of this study was to evaluate the effect of flaxseed oil (omega-3 supplementation) on tobacco dependence, craving, withdrawal symptoms, and haematological parameters in tobacco users. Methods In this randomised, single-blind, placebo-controlled study, 104 tobacco users (54 in the omega-3 group and 50 in the placebo group) were supplemented with 10 ml of food-grade flaxseed oil and 10 ml of placebo for six months, respectively. Their demographics, frequency of daily tobacco use, tobacco dependence, tobacco craving, tobacco withdrawal symptoms, and complete blood count (CBC) were assessed at baseline (before intervention) and after a six-month intervention. Results The demographic characteristics of the two groups were similar except for gender at baseline. There were 50 males and four females in the omega-3 group, while there were 42 males and eight females in the placebo group. After a six-month flaxseed oil intervention, BMI values showed a significant reduction (p = 0.0081) in the omega-3 group when compared to baseline; however, CBC parameters did not show any significant changes when comparing baseline to follow-up values. On the contrary, haemoglobin and red blood cells (RBCs) showed significant changes when comparing the follow-ups of the omega-3 group with the placebo group, indicating p = 0.0016 and p = 0.0163, respectively. Also, omega-3 effectively decreased daily tobacco use frequency (p<0.0001), tobacco dependence (p<0.0001), and craving (p<0.0001). Conclusion Supplementation of 10 ml of flaxseed oil per day (omega-3 FA) for six months significantly reduced tobacco dependence and cravings. Additionally, the flaxseed oil supplementation effectively reduced the frequency of daily tobacco intake and modulated tobacco withdrawal symptoms. Thus, our results suggest that flaxseed oil supplementation is a useful adjunct for tobacco users who intend to quit tobacco use.
OBJECTIVES: To study sociodemographic and clinical variables, including psychiatric co-morbidities, in patients with irritable bowel syndrome. METHODS: A total of 158 patients attending a medical gastroenterology clinic in a tertiary care center in Northern India were screened, from whom 100 were selected for the study. Rome IV criteria were used to diagnose IBS, and the severity of symptoms was assessed by the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS). Psychiatric co-morbidities were screened via clinical evaluation, and if present, a diagnosis was made as per DSM-5. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and Somatic Symptom Scale-8 (SSS-8) were used to assess depression, anxiety, stress, and somatic symptoms. RESULT: The mean age of cases was 35.6 years' old, and the majority of cases (i.e., 38.0%) were between 18 and 29 years' old. Males comprised 62.0% of the sample and females 38.0%. Moderate IBS was present in 61.0% of the cases. Evaluation via DASS-21 revealed that 53.0% were in the moderate category of depression, 43.0% had moderate anxiety, and 36.0% had moderate stress. The somatic symptom scale revealed that 48.0% patients were in the high category. Psychiatric co-morbidities were present in 29.0% of cases. Depressive disorders were the most common psychiatric co-morbidity. CONCLUSIONS: Patients with IBS presenting to a tertiary care center in Northern India were primarily young males living in semi-urban areas who belonged to the Hindu religion, were married, and had a nuclear family. Patients with IBS commonly have associated psychiatric disorders; anxiety disorders and depression are most common.
In the present study, the effect of mild to high-temperature regimes on the quasi-static and dynamic tensile behaviours of Barakar sandstone from the Jharia coal mine fire region has been experimentally investigated. The experimental work has been performed on Brazilian disk specimens of Barakar sandstone, which are thermally treated up to 800 °C. The quasi-static and dynamic split tensile strength tests were carried out on a servo-controlled universal testing machine and Split Hopkinson Pressure Bar (SHPB), respectively. Microscopic and mineralogical changes were studied through a petrographic investigation. The experimental results suggest the prevalence of both, static and dynamic loading scenarios after 400 °C. Up to 400 °C, the quasi-static and dynamic tensile strengths increased due to the evaporation of water, which suggests a strengthening effect. However, beyond 400 °C, both strengths decreased significantly as newly formed thermal microcracks became prevalent. The dynamic tensile strength exhibits strain rate sensitivity up to 400 °C, although it shows a marginal decline in this sensitivity beyond this temperature threshold. The Dynamic Increase Factor (DIF) remained constant up to 400 °C and slightly increased after 400 °C. Furthermore, the characteristic strain rate at which the dynamic strength becomes twice the quasi-static strength remains consistent until reaching 400 °C but steadily decreases beyond this temperature. This experimental study represents the first attempt to validate the Kimberley model specifically for thermally treated rocks. Interestingly, the presence of water did not have a significant impact on the failure modes up to 400 °C, as the samples exhibited a dominant tensile failure mode, breaking into two halves with fewer fragments. However, as temperature increased, the failure behaviours became more complex due to the combined influence of thermally induced microcracks and the applied impact load. Cracks initially formed at the centre and subsequently, multiple shear cracks emerged and propagated in the loading direction, resulting in a high degree of fragmentation. This study also demonstrates that shear failure is not solely dependent on the loading rate but can also be influenced by temperature, further affecting the failure mode of the sandstone.
BACKGROUND: Patients with major depressive disorder who have a poor or inconsistent response to antidepressants have been treated using transcranial direct current stimulation (tDCS). Early tDCS augmentation may help with the early amelioration of symptoms. In this study, the efficacy and safety of tDCS as early augmentation therapy in major depressive disorder were evaluated. METHODS: Fifty adults were randomized into two groups and were administered either active tDCS or sham tDCS, along with escitalopram 10 mg/day. A total of 10 tDCS sessions with anodal stimulation at the left dorsolateral prefrontal cortex (DLPFC) and cathode at the right DLPFC were given over two weeks. Assessments were done using Hamilton Depression Rating Scale (HAM-D), Beck's Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAM-A) at baseline, two weeks, and four weeks. A tDCS side effect checklist was administered during therapy. RESULTS: A significant reduction in HAM-D, BDI, and HAM-A scores were observed in both groups from baseline to week-4. At week-2, the active group had a significantly greater reduction in HAM-D and BDI scores than the sham group. However, at the end of therapy, both groups were comparable. The active group was 1.12 times more likely to experience any side effect than the sham group, but the intensity ranged from mild to moderate. CONCLUSION: tDCS is an effective and safe strategy for managing depression as an early augmentation strategy, and it produces an early reduction of depressive symptoms and is well tolerated in moderate to severe depressive episodes.
Depressive Disorder, Major , Transcranial Direct Current Stimulation , Adult , Humans , Depressive Disorder, Major/therapy , Single-Blind Method , Treatment Outcome , Psychiatric Status Rating Scales , Double-Blind Method , Prefrontal Cortex
Objectives: There is a bidirectional and complex interplay between psychiatric comorbidities and migraine. Migraine has been observed in 50-60% of patients with psychogenic non-epileptic seizures (PNES). Studies describe migraine as a medical comorbidity in PNES. However, there are limited studies on impact of PNES on migraine. We aim to see the impact of PNES on migraine. Materials and Methods: This cross-sectional and observational study was conducted at a tertiary-care center from June 2017 to May 2019. Fifty-two patients with migraine with PNES and 48 patients with migraine without PNES were included on the study. Migraine and PNES were diagnosed based on International Classification of Headache Disorders-3 (ICHD-3) and International League Against Epilepsy (ILAE) criteria, respectively. Headache intensity was assessed using visual analog scale. Comorbid depression, anxiety, and somatoform-symptom-disease were assessed using the Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, and DSM-5 criteria, respectively. Results: Females were common in both groups and the difference was statistically insignificant. Headache frequency was significantly more in patients with migraine with PNES (P < 0.05). However, headache intensity was similar in both groups. Patients with headaches and PNES identified triggers less commonly except for stress. Depression and somatoform symptom disorder were significantly more common in patients with migraine with PNES. Abnormal neurocircuitry involving frontal, limbic, and thalamic regions due to comorbid PNES may cause central sensitization, resulting in frequent migraine headaches which is further augmented by coexisting depression and somatoform-symptom-disease. Conclusion: Migraine with PNES patients suffers more frequent headaches than patients with migraine without PNES. They differ in various headache triggers, with mental stress being the predominant trigger.
Aim: The study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. Method: Total 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. Results: Majority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. Conclusion: Factors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.
INTRODUCTION: Drug-induced extrapyramidal syndrome (EPS) remains a major problem in clinical psychiatry. This study aimed to examine the factor structure of drug-induced extrapyramidal symptoms observed in patients with schizophrenia and assessed using the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). METHODS: The participants were 1478 patients with a diagnosis of schizophrenia whose EPS was assessed using the DIEPSS in India, Indonesia, Japan, Malaysia, and Taiwan in the 2016 REAP AP-4 study. The records of the participants were randomly divided into two subgroups: the first for exploratory factor analysis of the eight DIEPSS items, and the second for confirmatory factor analysis. RESULTS: The factor analysis identified three factors: F1 (gait and bradykinesia), F2 (muscle rigidity and tremor), and F3 (sialorrhea, akathisia, dystonia, and dyskinesia). CONCLUSION: The results suggest that the eight individual items of the DIEPSS could be composed of three different mechanisms: acute parkinsonism observed during action (F1), acute parkinsonism observed at rest (F2), and central dopaminergic mechanisms with pathophysiology other than acute parkinsonism (F3).
Antipsychotic Agents , Basal Ganglia Diseases , Parkinsonian Disorders , Schizophrenia , Humans , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Basal Ganglia Diseases/chemically induced , Basal Ganglia Diseases/diagnosis , Basal Ganglia Diseases/epidemiology , Parkinsonian Disorders/chemically induced , Parkinsonian Disorders/drug therapy , Japan
Background: Dhat syndrome, a clinical condition related to semen loss in urine often found among males in India, has rarely been described as a separate clinical condition in females. Women with the syndrome complain of passing vaginal discharge and can be excessively concerned and preoccupied with it, often attributing various physical symptoms to the loss of vaginal fluids. Aims: This study aimed to assess the sociodemographic and clinical profiles of female patients with Dhat syndrome and their perceived stress, disability and sexual functioning. Methods: Sociodemographic details of 70 females with non-pathological vaginal discharge were evaluated with a semistructured sociodemographic assessment. The phenomenology of the vaginal discharge was assessed with the Scale for Assessment of Female Dhat Syndrome Questionnaire. Anxiety and depressive symptoms were measured with the Hospital Anxiety and Depression Scale. Perceived stress in the past month and disability caused by the illness were assessed with the Perceived Stress Scale and the World Health Organization Disability Assessment Scale. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Level 2 Somatic Symptoms Scale was administered to rate the severity of somatic symptoms, and sexual functioning was evaluated using the Female Sexual Function Index (FSFI) scale for women who had had sexual intercourse in the past month. Results: The mean age of onset vaginal discharge was 23.0 (6.6) years. Biological factors, such as urinary tract infection, were the commonly attributed cause of the loss of vaginal fluids. Psychiatric comorbidity and perceived moderate stress in the past month were found in 38.6% and 68.6% of female patients with Dhat syndrome, respectively. Disability scores tended to be low. Among the females having had sexual intercourse in the past month, 48.3% had FSFI scores indicative of a female sexual disorder. Conclusions: The clinical presentation of women with non-pathological vaginal discharge is similar to that of males with Dhat syndrome. It requires comprehensive assessment and management that targets the biological, social and psychological factors and cultural issues.
Background: Dhat syndrome (DS) is considered a culture-bound syndrome of South East Asia. It is often associated with multiple sexual and psychiatric comorbidities. We aimed to assess the quality of life (QoL) and disability in patients of DS with and without comorbidity. Methods: This cross-sectional study included 117 patients with DS and 117 matched controls. DS was diagnosed based on the International Classification of Diseases, 10 version, Diagnostic Criteria for Research diagnostic criteria. Comorbidities were assessed on MINI 6.0.0, and the patients were divided into two groups (with and without comorbidity). The QoL and disability were estimated and compared between patients with and without comorbidity and their respective control groups consisting of healthy volunteers, using standardized tools. Result: Most of the patients were unmarried males aged 18 to 25 years and from rural backgrounds. Most of the patients (72.64%) had comorbidities (psychiatric/sexual). The QoL of patients with DS was poor compared to healthy individuals. The QoL of patients with comorbidity was worse than that of those without them (P < o.ooo). The disability of patients with DS was more than that of healthy individuals (significant in all domains of the World Health Organization Disability Assessment Schedule [WHODAS]). Conclusion: Patients having DS had poor QoL and higher disability than healthy controls. Patients having psychiatric or sexual comorbidities had less QoL and higher disability compared to healthy controls and those without comorbidities.
Aim: To study the sociodemographic and clinical profile of subjects receiving disability certificates (DCs) issued for psychiatric disorders across multiple centres in India. Materials and Methods: Eleven centres, including ten government and one non-governmental organization spread across the country, participated in the study. Data on the sociodemographic and clinical profiles of patients who were issued DC in the calendar year 2019 were collected on a proforma designed for the study. Results: Overall, 2018 patients were issued DC for various psychiatric disorders across 11 centres in 2019. The number of certificates issued across different centres varied from 34 to 622. In terms of diagnostic profile, intellectual disability accounted for most of the certificates issued. In terms of psychiatric diagnosis, schizophrenia was the most common psychiatric diagnosis, followed by bipolar disorder, for which a DC was issued. When the diagnosis was considered, centre wise, intellectual disability (6 centres), mental illness (MI; 4 centres), and autism and specific learning disability (1 centre) accounted for the most DCs issued. Schizophrenia (9 centres), bipolar affective disorder (1 centre), and dementia (1 centre) were the most common MI for which DC was issued. Across centres, more than two-thirds of DC were issued to males. Conclusion: There is a wide variation in the number and clinical profile of DC issued across centres.
Context: Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines released in 2020 have provided legal backing for telepsychiatry practice. Aims: To understand the current telepsychiatry practices in India. Settings and Design: An online survey was conducted after ethics approval by the IPS Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose email address was available with the society, were sent the survey link by email. Methods and Material: Information about existing telepsychiatry consultation practices in India was collected between June and July 2020. Statistical Analysis Used: Frequency, percentages, mean, and standard deviation were calculated. Results: 340 responses were analyzed. Nearly three-fourths of the responders used smartphones (n = 260, 76.47%) for audio consultations (n = 196, 57.65%). Among those who were using a dedicated software (n = 36), one-third used the Zoom software (n = 12, 33.33%). Nearly three-fourths (n = 218, 73.4%) provided prescriptions with their registration number on a letterhead in the form of an email or text message. Two-thirds of the responders (n = 228, 67.06%) felt that in-person consultation is better. Many preferred a combination of voice, video, and text including emails (n = 134, 42.01%). Conclusions: This online survey showed that the use of technology has caught up with the practicing psychiatrists. Many are practicing telepsychiatry either formally or informally in India and are comfortable and satisfied with the telepractice.
Parkinson's disease (PD) is a heterogeneous progressive neurodegenerative disorder, with a triad of motor symptoms with akinesia/bradykinesia, resting tremor (4-6 Hz), and rigidity. It is the second most common neurodegenerative disease after Alzheimer's disease. The overall management of PD depends on the status of symptoms, functioning of the patients, impairment, disability, and its impact on quality of life. Depression, anxiety disorders, apathy, anhedonia, psychosis, cognitive impairments, dementia, and impulse control disorders (ICDs) are the common psychiatric symptoms/disorders comorbid with PD. Depression remains the most common psychiatric disorder reported to be comorbid with PD. Several pharmacological and nonpharmacological management strategies are used for the treatment of comorbid psychiatric disorders in PD. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are used to treat depression in patients with PD. The best evidence of efficacy in PD psychosis is for clozapine and pimavanserin. The treatment for cognitive impairments in PD remains poorly researched. Rivastigmine is the only approved treatment for PD as per the Food and Drug Administration. Pramipexole, a dopamine agonist (DA), is reported to cause improvement in the symptoms of decreased willingness in apathy. The treatment approaches for different sleep disorders in PD are different. Identifying the cause, reviewing the patient's ongoing medications, and evaluating the impact of comorbid medical conditions and sleep hygiene are common to all conditions related to sleep disorders. The first approach for treating ICD symptoms is the reduction or discontinuation of DAs. The psychiatric symptoms in patients with PD are highly prevalent, and their management should be included in the basic treatment algorithm for PD. This paper summarizes common psychiatric symptoms/disorders in PD and their management approaches.
Context: Over the years, telepsychiatry services have expanded in many institutes. The Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines (TPOG) released in 2020 have been received by the fraternity with a mixture of apprehension, relief, and dissatisfaction on the list of drugs provided in Lists O, A, B, and C. Many psychiatrists have raised the issues of having a consensus in the formulation of List A. Aims: To draw consensus on the medications that can be listed in Lists O, A, B, and C in TPOG-2020. Settings and Design: This was an online survey with ethics approval by the Indian Psychiatric Society Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose E-mail address was available with the society, were sent the survey link by E-mail. Methodology: Opinions and suggestions on Lists O, A, B, and C of TPOG-2020 and reasons for the suggestions were collected. Statistical Analysis Used: Frequency, percentages, mean, and standard deviation were calculated. T-test and Chi-square tests were used to see the influence of demographics on the concurrence of the lists. Results: Responses from 340 responders were analyzed. Majority of the responders agreed that List O (277, 85.5%), List B (263, 82.4%), and List C (223, 69%) are apt except for List A (162, 50.3%). Conclusions: This online survey showed that majority of the responders agreed to the lists except for List A. The approach taken to include the medications in List A, which was to include the essential drugs, has various benefits. However, the lists are not final, and the results of this survey may become an impetus to modify the list in the next edition of TPOG.
Context: Telepsychiatry is being practiced in India for many years but was formalized only in 2020. It has many advantages and disadvantages. Aims: This study aimed to understand the perceived advantages and disadvantages of telepsychiatry practices in India. Settings and Design: An online survey with ethics approval by the Indian Psychiatric Society (IPS) Ethics Review Board. All psychiatrists who are members of the IPS and whose email address was available with the society were sent the survey link by email. Methodology: Information about existing telepsychiatry consultation practices in India and perception of advantages and disadvantages by the practitioners were collected between June and July 2020. Statistical Analysis: Frequency, percentages, mean, and standard deviation were calculated. Results: Responses by 340 responders were analyzed. Majority of the responders felt that telepsychiatry would provide easy accessibility to mental health services (n = 283, 83.24%) and would lead to less exposure to infections (n = 222, 65.29%). Half of the responders (n = 177, 52.06%) felt that there would be an increased doctor shopping resulting in poor care and nearly three-fourth (n = 245, 72.06%) felt that mental health professionals would fall into a problem while dealing with a suicidal or a homicidal patient. Some expressed that the inability to do physical and central nervous system examinations could lead to missing out comorbidities. About one-third (n = 117, 36.56%) felt that the patient recording the consultation would be a legal issue. Conclusions: This online survey showed that psychiatrists perceive many advantages and some disadvantages in practicing telepsychiatry.
