Selecting a thesis topic: A postgraduate's dilemma.

It is said that well begun is half done. Choosing a thesis topic and submitting a research protocol is an essential step in the life cycle of a postgraduate resident. National Medical Commission of India mandates that all postgraduate trainees must submit at least one original research work (dissertation), one oral paper, one poster, and one publication to be eligible for final year examination. It is the duty of the faculty to ensure that trainees take active interest and submit their theses on time. However, their journey is often marred by multiple challenges and hurdles. The literature was searched from year 2000 onwards till 2011 using Pubmed, ResearchGate, MEDLINE, and the Education Resources Information Centre databases with terms related to residency training, selecting thesis topic, challenges or hurdles, and conversion of thesis into journal article. Existing literature on the subject matter is sparse. Current article advocates promotion of ethical and original research during postgraduation and proposes a checklist for residents before submission of their proposals.

Comparative efficacy of high-frequency repetitive transcranial magnetic stimulation to left dorsolateral prefrontal cortex as an augmentation strategy versus pharmacological augmentation in non-psychotic, unipolar, treatment-resistant depression: A randomized controlled trial.

Background: Depression causes significant morbidity, disability and mortality, along with socioeconomic losses. Patients with depression who don't remit even with the second trial of anti-depressants need optimization, combination or augmentation strategies. Pharmacological strategies sometimes have unacceptable adverse effects. Aim: The aim of this study is to compare the efficacy of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) to left dorsolateral prefrontal cortex (DLPFC) with that of pharmacological augmentation strategies in unipolar non-psychotic treatment-resistant depression. Method: This is a randomized controlled trial. Subjects: Cases of unipolar, non-psychotic, treatment-resistant depression between ages 20 and 60 years were taken. Period of Study: The study period was from November 2016 to May 2018. Randomization: Cases diagnosed as per ICD-10 criteria by a qualified psychiatrist. Cases of treatment-resistant depression (100) were divided into two arms by using a random number generator: rTMS arm and treatment as usual (TAU) arm. Intervention: HF-rTMS to left DLPFC (rTMS group) and pharmacological augmentation with lithium, serotonin-dopamine antagonist, buspirone or thyroxine. Results: In the rTMS arm, 44 patients and in TAU arm 41 completed the study. After 4 weeks of treatment augmentation, rTMS and TAU groups showed response rates of 52% and 46%, respectively. The difference between the two groups in terms of number of responders at the end of 4 weeks is not statistically significant. Additionally, factors associated with good response to rTMS were absence of a family history of psychiatric illness, no concomitant psychoactive substance use, being first episode of depression and mild-moderate severity of illness. Conclusion: The study did not find rTMS augmentation to be significantly better than standard pharmacological augmentation therapies.

Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do?

Background: Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio. Methodology: Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio. Results: One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable. Conclusion: It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.

Cry in the sky: Psychological impact on drone operators.

Drone operations have added a new chapter to modern warfare. They may not guarantee immediate territorial gains but can significantly influence ideological and political alignment of the adversary at a cost which is much lower than conventional war. However, drone operators, which include remote pilots, intelligence coordinators, and other support staff, may face important psychological issues which may affect their mental health and operational efficiency. We conducted a nonsystematic narrative review of the articles dealing with the issue and found that drone operators and support staff have higher chances of suffering from emotional disengagement, Post Traumatic Stress Syndrome (PTSD), emotional exhaustion, and burnout. The scope of the article does not cover the psychological effect on the targeted populations or political and ethical issues dealing with drone warfare.

Critical appraisal of journal article by psychiatry PG residents using a new module: Impact analysis.

BACKGROUND: A gap exists from evidence-based medicine (EBM) to clinical practice and there is a felt need to bridge this. Critical appraisal of scientific articles during Journal club by postgraduate (PG) residents will help them to understand and apply the scientific evidence into best clinical practice. Hence, a new module of critical appraisal of journal articles was used for Psychiatry Residents in a Medical College and its impact was assessed. MATERIALS AND METHODS: Nine psychiatry PG residents from three academic batches participated in the study after informed consent and Institutional ethical committee clearance. They were trained in the Colorado Psychiatry EBM Examination Test module. Subsequently, three consecutive journal article presentations of them were assessed under seven Subtests of the module. RESULTS: There was gradual increase in the assessment scores of all PG residents with each journal article presentation. They also expressed satisfaction of the assessment method and felt confident of applying the principles of critical appraisal in their clinical practice in future. CONCLUSION: This study evaluated the impact of a new module of critical appraisal of journal article by psychiatry PG residents. It was found to be acceptable by residents and improved their competency to apply literature-based EBM into their clinical practice. It is recommended for further multicentric evaluation on a larger sample.

Prevalence of childhood depression in school going adolescents in an urban Indian school.

BACKGROUND: Understanding the prevalence of a psychiatric disorder among children is essential for formulating sound public health policy. AIM: This study is aimed to estimate the prevalence of depression in urban school-going adolescents and its association with age, sex, and birth order. MATERIALS AND METHODS: A total of 500 participants in the age group 12-16 years from a working-class community, studying in an urban school, were selected for the study. The children with a score greater than or equal to 19 on the CDI scale were taken for the second phase, and diagnosis of depression was confirmed by a psychiatric consultant through a clinical interview. In clinically diagnosed cases, all help was rendered, including follow-up. RESULTS: The prevalence of clinical depression among school-going children of age group 12-16 years was 8.4%. There was no significant gender difference in the prevalence of clinical depression. Significantly, more children had clinical depression in the age group of 14-16 years than in the 12-14 years of age group. Depressive symptoms were more among children with first birth order. CONCLUSIONS: These results show that depression is common in school going urban adolescents in India and highlight the need for screening school-age children for depression so that early intervention can be provided.

Available videoconferencing freeware and medical education.

BACKGROUND: Traditionally medical education involves classroom teaching, small group discussions and bed-side clinics. These have become difficult to conduct in times of the COVID-19 pandemic. Video-conferencing software and apps provide pragmatic alternatives for medical education in this scenario. However, the apps are not designed specifically for medical education. In this background, we aimed to review available video-conferencing freeware (platforms/apps) for their suitability in imparting post-graduate medical education. METHODOLOGY: Software and apps were searched on Android and iOS platforms. Freeware were selected based on pre-defined criteria. They were evaluated for features supporting post-graduate medical education like participant numbers, time limit, user comfort and security features. RESULTS: Our search yielded 118 video conferencing software and apps. Of these, 07 free apps met the initial inclusion and exclusion criteria. 'Say Namaste' was included post-hoc. Most apps allowed adequate numbers of participants and were comfortable for users. Only two apps had end-to-end encryption. CONCLUSION: Video-conferencing freeware can serve as a viable alternative for some aspects of medical teaching. Provision of certain additional features would make these apps more effective for post-graduate medical education.

Outcome of a "modified brief intervention" program delivered at work place for a population with hazardous alcohol use.

INTRODUCTION: At the population level, screening and brief intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. Hence, a study was conducted to assess the outcome of a "modified brief intervention" program delivered at workplace in a group setting for the participants identified with hazardous alcohol use pattern, as a secondary prevention measure. MATERIALS AND METHODS: Study was a pre- and post-intervention study without a control group. Following an educational lecture, conducted by a mental health team including a psychiatrist, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those screened positive for hazardous alcohol use were given "modified brief intervention" in a group setting at their workplace which consisted of two semi-structured sessions of 1-h duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session focused on relapse prevention. Three months later, the outcomes were assessed using a semistructured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software. RESULTS: No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective. Only 3 months of observation is a limitation. CONCLUSION: The study provides an efficient secondary prevention model to reduce hazardous drinking at the population level needing less workforce, cost, and time.

Impact of eclectic cognitive retraining in a case of high-altitude cerebral edema.

Cognitive impairment in cases of high-altitude cerebral edema is a less researched area of neuropsychiatry. Usually, it presents with depressive symptoms and can sway the treatment on the lines of organic depressive disorder and pseudodementia. We report one such case of which presented with depressive symptoms with cognitive dysfunction. The diagnosis was later revised to organic amnesic syndrome. His cognitive deficits improved with the use of cognitive retraining, especially with the use of mobile-based applications.

Adjunctive dexmedetomidine for treatment of delirium tremens: Case report and brief review.

Alcohol withdrawal delirium (delirium tremens [DT]) is a medical emergency. Gamma-aminobutyric acid type A agonists (benzodiazepines [BZDs]) are the mainstay of treatment. Resistant alcohol withdrawal requires adjunctive medications along with BZDs and supportive care. DT is associated with significant autonomic dysfunction (sympathetic hyperactivity). Dexmedetomidine is a selective a2-adrenergic receptor agonist which reduces sympathetic over-activity and agitation in delirious patients. We present a case of alcohol withdrawal delirium (DT) who responded well to adjunctive dexmedetomidine infusion resulting in reduced sympathetic activity and reduced dose requirement of BZDs.

Transcranial magnetic stimulation: A review of its evolution and current applications.

Repetitive transcranial magnetic stimulation (rTMS) is a recently developed noninvasive brain stimulation method for the treatment of psychiatric and neurological disorders. Although, its exact mechanism of action is still not clear, current evidence points toward its role in causing long-term inhibition and excitation of neurons in certain brain areas. As evidence steadily grows in favor of rTMS as a therapeutic tool; there is a need to develop standardized protocols for its administration. There have been no reports of any serious side effects with rTMS, though its use is restricted in those having magnetic implants or recent adverse neurological or cardiac event. Of all the psychiatric indications of rTMS, the evidence is most robust for treatment of refractory unipolar depression. This paper reviews contemporary literature highlighting the evolution of rTMS as a diagnostic and therapeutic tool, especially in the management of treatment-resistant depression.