Assessment of potential predictors affecting preoperative anxiety in Indian children- A prospective observational study.

Background and Aims: Preoperative anxiety is a common problem among children undergoing surgery. The aim of the study was to assess the incidence and identify various predictors of preoperative anxiety in Indian children. Material and Methods: A prospective, observational study was conducted on 60 children of the American Society of Anesthesiologists Physical status 1/2, aged 2-6 years and scheduled for elective surgery under general anesthesia in a tertiary care teaching hospital. Preoperative parental anxiety was assessed using the State-Trait Anxiety Inventory questionnaire. The children's anxiety was assessed in the preoperative room, at the time of parental separation, and at the induction of anesthesia using modified Yale Preoperative Anxiety Scale (mYPAS) scoring by an anesthesiologist and a psychologist. Sedative premedication was employed prior to parental separation. Logistic regression analysis was carried out to identify the possible predictors of anxiety. Results: The incidence of high preoperative anxiety among the studied children was 76% in the preoperative room, 93% during parental separation, and 96% during anesthetic induction. Among the nine possible predictors identified on univariate regression, the presence of siblings was found to be a significant independent predictor on multivariate regression analysis (P = 0.04). The inter-rater agreement was excellent for the assessment of preoperative anxiety using mYPAS by the anesthesiologist and psychologist (weighted Kappa, k = 0.79). Conclusion: The incidence of preoperative anxiety in Indian children in the age group of 2-6 years is very high. The preop anxiety escalates progressively at parental separation and induction of anesthesia despite sedative premedication. The presence of siblings is a significant predictor of preoperative anxiety.

Assessment of Self-Esteem and Quality of Life in Patients with Complete Unilateral Cleft Lip and Palate Undergoing Orthodontic Treatment.

Objective: To assess the self-esteem and quality of life (QOL) in patients with complete unilateral cleft lip and palate (UCLP) who were undergoing orthodontic treatment. Materials and Methods: This cross-sectional study was conducted on a total sample of 300 individuals consisted of 150 patients with UCLP (Group I) and 150 normal controls (Group II) with an age range of 10-25 years, who were undergoing comprehensive orthodontic treatment from December 2016 to December 2018. The Self Esteem and QOL were assessed using the Rosenberg Self Esteem scale (RSE) and Modified Paediatric QOL Inventory Scale (M-PQOL), respectively, in Group I and II. Results: The comparison of overall mean scores of responses to RSE questionnaires showed nonsignificant differences for all the responses and was significant only for RSE 6 and RSE 8 in the age group of 10-15 years and 21-25 years, respectively, and nonsignificant for all other questions in all the age groups. The comparison of overall mean scores of M-PQOL for the total sample showed nonsignificant differences in Group I and II for physical functioning, emotional functioning, and school functioning domain, and were highly significant differences (P ≤ 0.001) in the social functioning domain and M-PQOL 12 and M-PQOL 21. Conclusions: This study demands a definite need of a psychologist/psychiatrist among the cleft care team to counsel the patients with cleft during orthodontic treatment for motivating them to gain self-respect and acceptance in the society as certain aspects, particularly social functioning domain made them feel different from normal children because of the functional and aesthetic problems.

Is the temperamental trait of high persistence protective in siblings? - A comparative, exploratory study of healthy siblings, and attention deficit hyperactivity disorder probands.

Background: Study of temperament in first-degree relatives is an important line of inquiry to substantiate temperament as an etiological marker. Aim: This study aims to compare temperament in children with attention deficit hyperactivity disorder (ADHD) and their healthy siblings and to assess the association between ADHD symptoms and temperament dimensions in healthy siblings. Settings and Design: The study was carried out in the outpatient department of psychiatry in a tertiary care teaching hospital. A cross-sectional design with nonprobabilistic sampling technique was used for data collection. Materials and Methods: A hundred children (50 children with ADHD and 50 siblings-one for each child with ADHD) were assessed retrospectively on temperament measurement schedule (TMS) and conners parent rating scale-revised: short form (CPRS-R: S). Statistical Analysis: IBM SPSS Statistics for Windows, Version 20.0 was used for statistical analysis. Mean and standard deviation and frequency and percentage were computed for continuous and categorical variables, respectively. Student's t-test was computed to compare means of the two groups and regression analysis was computed to see for the variance in ADHD subscale scores explained by temperament scores on TMS. Results: Siblings scored highest on the intensity of reaction and lowest on threshold of responsiveness. Compared to probands, siblings scored significantly higher on persistence and lower on activity level, even after controlling for gender. Persistence trait had a significant negative correlation with and explained 7.4% to 21% of variance of all CPRS-R: S subscales. Persistence and distractibility together explained 23.2% of inattention scores. Conclusion: Higher persistence in siblings appears to offer protection to these at-risk individuals who do not have ADHD; favoring the dual pathway model of ADHD.

Efficacy of screening and brief intervention for hazardous alcohol use in patients with mood disorders: A randomized clinical trial from a psychiatric out-patient clinic in India.

AIM: To determine the efficacy of individual-based, face-to-face screening and brief intervention (SBI) for hazardous alcohol use among treatment-seeking outpatients with mood disorders. METHODS: It was a parallel-group, single-blind, randomized controlled trial of 84 participants who met the selection criteria for hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8-19. Participants were randomly allocated to either SBI or general advice group. Both groups had received a standard care for mood disorders. The outcome was assessed after 3 months. The primary outcome was a change in the mean AUDIT score and the secondary outcomes were a change in frequency of heavy episodic drinking and stages of motivation. RESULTS: Majority (60%) had major depressive episodes. There was no significant difference in baseline demography and clinical variables between the groups. Both intention to treat and per-protocol analyses showed a small but significant effect of SBI on mean AUDIT score. Age, baseline AUDIT, and motivation did not moderate the effect. SBI was associated with a significant decrease in the frequency of heavy drinking and improvement in stages of motivation. CONCLUSION: SBI among patients with mood disorders had a small but significant effect on alcohol use.

Effect of Social Networking Sites on the Quality of Life of College Students: A Cross-Sectional Study from a City in North India.

INTRODUCTION: With the advent and extensive use of the Internet and smartphones, social networking has become a pervasive part of human interaction. The use of these social networking sites or the Internet affects the physical, mental, and spiritual health of the people. Hence, there is need to understand how the time spent on social networking is affecting the quality of life (QOL) as a whole, especially among college-going students who are most likely users of social networking sites (18-21 years). MATERIALS AND METHODS: A cross-sectional survey was conducted among 220 college-going students (18-21 years) in Chandigarh in 2012. The data were collected using a pretested self-administered questionnaire, adapted from Young's Internet usage questionnaire. Appropriate statistical analysis was done. RESULTS: Almost all (98%) of the respondents use the Internet. As compared to nondaily users of social networking sites, daily users were better able to handle stress related to (1) relationships (moderate to severe stress among daily users vs. nondaily users, 15.2% vs. 30.5%) and (2) work (moderate to severe stress among daily users vs. nondaily users, 18.2% vs. 35.4%). The daily users of social networking sites feel significantly more satisfied with their classmates, the way they handle the problems, their physical appearance, and their accomplishments in their life. CONCLUSION: Social networking sites are steadily penetrating in the lives of adolescents in India. The advantages on quality of life for daily users of social networking sites versus nondaily users are enormous. Also currently, Internet use might not have reached the levels where it embarks on the existing state of health; therefore, continuous and critical observation of the changing trends is warranted.

Differentiation of Recurrent/Residual Glioma From Radiation Necrosis Using Semi Quantitative 99mTc MDM (Bis-Methionine-DTPA) Brain SPECT/CT and Dynamic Susceptibility Contrast-Enhanced MR Perfusion: A Comparative Study.

PURPOSE: In this study, Tc MDM (bis-methionine-DTPA) SPECT was used for the detection and differentiation of recurrent/residual glioma from radiation necrosis and the results were compared with dynamic susceptibility contrast-enhanced (DSCE)-MRI and clinical findings. MATERIALS AND METHODS: Twenty-eight patients (18 men and 10 women; mean ± SD age, 41.4 ± 15.03 years) with histologically proven glioma (grade IV, 14; grade III, 7; grade II, 7) who were planned for postsurgical standard radio/chemo therapy were recruited prospectively. All the patients underwent technetium Tc MDM SPECT/CT and DSCE-MRI imaging at 6 months after surgery/radio-chemotherapy, 9 of 28 patients also underwent SPECT imaging at 1 to 2 weeks after surgery. RESULTS: Tc MDM SPECT/CT analysis demonstrated significantly higher target to nontarget (T/NT) ratio of the radiotracer in tumor recurrence than in radiation necrosis (3.59 ± 1.70 vs 1.16 ± 0.42). Likewise, the normalized cerebral blood volume (nCBV) values in patients with tumor recurrence were also significantly higher than in radiation necrosis (5.16 ± 2.30 vs 1.63 ± 0.94). A positive correlation (rho = 0.823, P < 0.0001) between T/NT ratios and nCBV was observed. The cutoff T/NT ratios and nCBV values estimated by receiver operating characteristic analysis were greater than 1.50 (area under the curve, 0.944 ± 0.34) and greater than 2.12 (area under the curve, 0.931 ± 0.39), respectively. Combining the results of Tc MDM SPECT/CT, DSCE-MRI, and clinical findings, diagnosis of recurrent/residual glioma or radiation necrosis was made in 18 and 10 patients, respectively. Sensitivity and specificity of 2 techniques were comparable, that is, 92.0%: 78.6% for MDM SPECT/CT and of 92.0%: 71.4% for DSCE-MRI, respectively. CONCLUSION: Thus, combining MDM SPECT with DSCE MRI may provide an accurate method for differentiation of tumor recurrence from radiation-induced necrosis in glioma patients.

Predictors of Pre-operative Anxiety in Indian Children.

OBJECTIVE: To identify the predictors of pre-operative anxiety in school-going children in India. METHODS: A prospective observational study was done at a tertiary care teaching hospital. Children aged 7-12 y scheduled for elective surgery and their parents were enrolled. Pre-operative anxiety in children and parents was assessed using STAI-C and STAI-P questionnaires respectively. The child's anxiety in pre-op room, at the time of parental separation and induction of anesthesia were assessed using m-YPAS scale. Possible predictors of anxiety under 'individual', 'social' and 'healthcare' domains were analyzed using logistic regression. The quality of mask induction of anesthesia was assessed using Induction Compliance Checklist. RESULTS: Sixty children completed the study successfully. Receiver operating characteristic (ROC) curve indicted mYPAS score ≥ 30 (observed score) to identify children with high anxiety as identified by STAI-C ≥37 (self-reported score). The incidence of high anxiety escalated from pre-operative time (48%) to the time of parental separation (72%) and increased further at anesthetic induction (95%). Parental anxiety (p = 0.03) and socioeconomic background (p = 0.03) were significant predictors of the child's pre-operative anxiety. The presence of >4 people at induction (p = 0.002), but not pre-operative anxiety, was found significantly more in children with poor quality of mask induction. CONCLUSIONS: The incidence of peri-operative anxiety in Indian children is significant. Parental anxiety and socioeconomic background were found significant predictors of high pre-operative anxiety in our set-up.

The utility of modified version of sentence completion test for children and adolescents.

INTRODUCTION: Sentence completion test (SCT) is a projective test used widely by clinicians and psychologists to explore the needs, inner conflicts, fantasies, attitudes, aspirations, adjustment difficulties, and sexual abuse in the children and adolescents. AIM: The aim of the study is to modify the existing SCT (Form S) for children and adolescents and to corroborate with clinical history. METHODOLOGY: A pilot testing was done on 35 children and adolescents who were referred to the Department of Clinical Psychology section for evaluation of conflicts after a detailed evaluation by psychiatrist(s). The clients were administered both the unmodified and the modified SCT. The information obtained was compared between (i) unmodified and the modified SCT and (ii) between clinical history and modified SCT. The psychologist was blind to the assessment of the patient done at the time of workup by a psychiatrist. The two information were analyzed. Descriptive analysis was carried out. RESULTS: The modified version of SCT gave more comprehensive information on all areas of the patient's life compared to older version. The information obtained corroborated with the clinical history explored by the psychiatrist. This test can be administered with ease and can yield detailed information in a wide range of stress-related and neurotic disorders, which can be utilized for clinical case management. CONCLUSION: The modified SCT may better complement clinical history in eliciting comprehensive information on psychosocial issues and better formulation of management plan.

Burden of caregiving and its impact in the patients of acute lymphoblastic leukemia.

AIM: This study aims to study the caregiver burden and its correlates among the caregivers of adolescent and adult patients of acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: Sixty caregivers of patients with ALL were assessed on Family Burden Interview Schedule (FBI), Caregiver Strain Index, multidimensional aspect of perceived social support scale, Cognitive-Behavioral Avoidance Scale, ways of coping checklist, and General Health Questionnaire. RESULTS: Caregivers of patients with ALL reported high caregiver burden (FBI objective burden score - 21.77; subjective burden score - 1.83). Among the domains of FBI, the highest burden was seen in the form of financial burden closely followed by disruption of family leisure. Caregivers of male patients and those belonging to higher socioeconomic status reported higher level of objective burden. Caregiver burden was higher among caregivers who reported lower perceived social support, who more often used avoidance and escape as coping and less often used planful problem solving. Higher caregiver burden is associated with higher psychological morbidity. CONCLUSION: Caregivers of patients with ALL experience high level of caregiver burden and it is associated with lower social support and more often use maladaptive coping strategies.

Utility of the revised Edmonton Symptom Assessment System (ESAS-r) and the Patient-Reported Functional Status (PRFS) in lung cancer patients.

BACKGROUND: Symptom palliation is an important objective of treatment in advanced/metastatic lung cancer (LC). Significant psychological, minor physical symptoms and several social/emotional issues often go unnoticed. This prospective study aimed to evaluate utility of patients' perspectives [self-reported symptom assessment by revised Edmonton Symptom Assessment System (ESAS-r) and self-reported functional status by Patient-Reported Functional Status (PRFS)] amongst LC patients undergoing chemotherapy. METHODS: Consecutive newly diagnosed treatment-naïve LC patients attending a tertiary referral center in North India from January 2014 to March 2015 were included. All patients received standard histology-guided platinum-doublet chemotherapy. ESAS-r and PRFS questionnaires were administered under guidance, once at the time of initial assessment/diagnosis, repeated at start of chemotherapy, before C4, and after completion of chemotherapy (end of chemotherapy (EOCTx)). Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire was also administered. Baseline and post-treatment scores were compared. RESULTS: Majority of 133 patients enrolled were males (86.5%,n = 115), were current/ex-smokers (81.2%, n = 108), had advanced stage [IIIB = 30.1% (n = 40), IV = 52.6% (n = 70)], and were of non-small-cell type (NSCLC;84.2%,n = 112). On baseline ESAS-r, the highest mean symptom scores were observed for tiredness followed by anorexia. Mean ESAS-r scores before C4 as well as at EOCTX were significantly better than baseline ESAS-r scores in all its components except nausea. Similarly, PRFS before C4 and EOCTx was significantly improved compared to baseline. However, Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Status assessed at baseline did not show significant improvement at treatment completion. FACT-L score at EOCTx showed significant improvement from baseline in physical and functional well-being domains but not for social/family and emotional well-being domains. CONCLUSION: This study validated utility of ESAS-r and PRFS in Indian LC patients. These instruments should be used in routine clinical practice besides physicians' assessment of PS (KPS/ECOG).

Association of Chronic Subjective Tinnitus with Neuro- Cognitive Performance.

INTRODUCTION: Chronic subjective tinnitus is associated with cognitive disruptions affecting perception, thinking, language, reasoning, problem solving, memory, visual tasks (reading) and attention. OBJECTIVE: To evaluate existence of any association between tinnitus parameters and neuropsychological performance to explain cognitive processing. MATERIALS AND METHODS: Study design was prospective, consisting 25 patients with idiopathic chronic subjective tinnitus and gave informed consent before planning their treatment. Neuropsychological profile included (i) performance on verbal information, comprehension, arithmetic and digit span; (ii) non-verbal performance for visual pattern completion analogies; (iii) memory performance for long-term, recent, delayed-recall, immediate-recall, verbal-retention, visualretention, visual recognition; (iv) reception, interpretation and execution for visual motor gestalt. Correlation between tinnitus onset duration/ loudness perception with neuropsychological profile was assessed by calculating Spearman's coefficient. RESULTS: Findings suggest that tinnitus may interfere with cognitive processing especially performance on digit span, verbal comprehension, mental balance, attention & concentration, immediate recall, visual recognition and visual-motor gestalt subtests. Negative correlation between neurocognitive tasks with tinnitus loudness and onset duration indicated their association. Positive correlation between tinnitus and visual-motor gestalt performance indicated the brain dysfunction. CONCLUSION: Tinnitus association with non-auditory processing of verbal, visual and visuo-spatial information suggested neuroplastic changes that need to be targeted in cognitive rehabilitation.

Neuropsychological assessment in obsessive-compulsive disorder.

BACKGROUND: Neuropsychological deficits in obsessive-compulsive disorder (OCD) have been encouraged by brain imaging studies suggesting a putative fron to- striatial biological basis of the condition. Studies of neuropsychological functions in OCD have documented deficits in several cognitive domains, particularly with regard to visuospatial abilities, executive functioning, motor speed and memory. The Aim of the present study was to assess neuropsychological profile of patients with OCD. Objectives of the study were to assess and compare the neuropsychological profile of patients with OCD and matched healthy controls. MATERIALS AND METHODS: Twenty clinically stable outpatients with ICD-10 diagnosis of OCD and equal number of normal controls matched for age, education, gender and handedness were studied using a battery of neuropsychological tests. The tests consisted of verbal and performance tests of intelligence, memory, perceptual motor functions, set test and Wisconsin Card Sorting Test (WCST). RESULTS: On perceptual-motor functions, verbal fluency, executive functions (WCST), intelligence and memory patients with OCD did not show impairments comparable to healthy controls. An attempt to correlate the test findings with the duration of illness, stability of illness and the average drug dose was made and it was found that there was no correlation between the two. CONCLUSION: The present study does not provide evidence for a localized neuropsychological/cognitive impairment in OCD in cases that are stable for at least three months. Absence of impairments in perceptual-motor functions, verbal fluency, executive functions (WCST), intelligence, and memory does not agree with the results of other studies using these tests.

Correlation of defects in regional cerebral blood flow determined by 99mTc SPECT with residual neurocognitive testing abnormalities during and 3 months post exposure in acutely poisoned patients with organophosphates.

INTRODUCTION: Following acute organophosphate exposure, morphological changes in certain regions of the brain have been reported to develop within a few hours and involve neuronal degeneration. Single photon emission computed tomography (SPECT) has been used to determine changes in the regional cerebral blood flow and attempts have been made to correlate these changes with long-term neurological sequelae. PURPOSE OF STUDY: The aim of the study was to determine changes in the regional cerebral blood flow by 99mTc-ECD SPECT following acute organophosphate poisoning and to correlate these defects with abnormalities in neurocognitive testing carried out during admission and at 3 months post exposure, in order to determine whether any changes in the cerebral blood flow could help in predicting future development of neurocognitive deficit. PATIENTS AND METHODS: Twenty-eight patients with acute organophosphorous poisoning were included in the study. The inclusion criteria were a history of ingestion or accidental exposure, clinical features of cholinergic crises, and low serum acetylcholinesterase (AChE). Twenty age- and sex-matched patients from a previous study were used as controls for the neurocognitive tests. There were no controls for SPECT. RESULTS: Of the 28 patients studied, 27 had abnormalities in the regional cerebral blood flow on SPECT with men having significantly higher abnormalities than women (p < 0.05). The right side of the brain had more defects than the left, with the occipital lobes being the most commonly involved. Of seven neurocognitive function tests carried out on patients who had regional cerebral blood flow defects during admission, abnormalities were observed in six tests. In 18 of 26 patients who could be tested at 3 months post exposure, improvement was observed in Trail B and Visual retention tests. However, others tests remained significantly abnormal. CONCLUSION: We conclude that a single episode of clinically significant organophosphate intoxication can lead to persistent residual neurocognitive deficits. Detection of regional cerebral blood flow defects on 99mTc-ECD SPECT can possibly help in predicting long-term deficits in neurocognitive functions in such patients.

Incidence of childhood psychiatric disorders in India.

BACKGROUND: Studies on incidence of childhood mental disorders are extremely rare globally and there are none from India. Incidence studies though more difficult and time consuming, provide invaluable information on the pattern and causes of occurrence of mental disorders allowing opportunity for early intervention and primary prevention. AIM: This study aimed at estimating the incidence of psychiatric disorders in school children. MATERIALS AND METHODS: A representative sample of school children was assessed through a two stage evaluation process involving teacher's rating (N=963) and parent rating (N=873). Children who scored below the cut-off for psychiatric disorder (N=727) on both the screening instruments were re-contacted six years later. 186 children and their families were personally available for reevaluation. All the children and their parents were re-assessed on Parent Interview Schedule; Strengths and Difficulties Questionnaire: and detailed clinical assessment by a psychiatrist. Psychiatric diagnosis was made as per ICD 10 criteria. Data on children who were found to have psychiatric disorder were compared with those who did not have psychiatric disorders. RESULTS: 20 children out of 186 followed up had psychiatric disorder giving the annual incidence rate of 18/1000/yr. Children who had disorder at follow-up did not differ from those who did not on age, gender and psychological (temperament, parental handling, life stress and IQ) parameters at baseline. DISCUSSION: Incidence figures cannot be compared due to lack of any comparable studies. Factors associated with occurrence of new cases of psychiatric disorder and implications for future studies are discussed.

Auditory P300 event-related potentials and neurocognitive functions in opioid dependent men and their brothers.

Event-related-potentials (especially P300) and cognitive functioning as potential endophenotypes have not been studied in opioid dependence. We compared auditory P300 and cognitive functions in opioid-dependent men, their brothers and normal controls in an exploratory study with a view to find shared genetic factors in the development of opioid dependence. Twenty abstinent opioid-dependent males, their brothers and twenty matched controls were administered Wisconsin card sorting test (WCST), digit span test, trail making test-B, and auditory event-related potentials (P300) from an oddball task were recorded. The opioid dependent group performed the worst, the brothers group was intermediate, and the control group performed the best on tests of WCST, digit span and trail making test-B. The opioid dependent group had the smallest amplitudes and longest latencies of P300, and was followed by the brothers group who had an intermediate position and the control group who had the largest amplitudes and the shortest latencies. P300 and executive neurocognitive functions can be considered endophenotypes for the genetic study of vulnerability to opioid dependence. These are reflective of executive dysfunction and disrupted behavioral inhibition and the intermediate position of brothers suggests a common genetic substrate as a component of the etiology.

Wisconsin Card Sorting Test: Normative data and experience.

BACKGROUND: The Wisconsin Card Sorting Test (WCST) has been increasingly employed as a clinical neuropsychological instrument. However, in India the use of WCST is still in a relatively preliminary stage. AIM: To analyse the utility of WCST in the Indian population. METHODS: Fifty-three subjects in the age group of 20-50 years, comprising both men and women, were recruited for the study. The normality was established by administering the General Health Questionnaire as a screening instrument to evaluate their health status. The WCST was administered and the norms for various dimensions were established; these were compared with those of normal healthy individuals from the West as per the WCST manual. RESULTS AND CONCLUSION: The significance of differences and the experience of administration have been described. The present study found highly significant differences between the means on almost all WCST scores among the Western and the Indian sample, except for the number of correct responses.

Specific learning disabilities in children: deficits and neuropsychological profile.

The public is gradually becoming aware of specific learning disabilities (SLDs), which are very often the cause of academic difficulties. The aim of the study was to assess the SLDs in the clinic population at the Child and Adolescent Psychiatry Clinic at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh using the National Institute of Mental Health and Neurosciences SLD index and subsequently to assess the children's neuropsychological functions using a battery of tests. Thirty-five children in the age range of 7-14 years (both boys and girls) were recruited as the cohort, diagnosed clinically and assessed using the battery of tests for SLDs and neuropsychological tests consisting of the PGIMER memory scale for children, the Wisconsin card sorting test, the Bender visuo-motor gestalt test and Malin's intelligence scale for Indian children. The study revealed deficits in language and writing skills and impairments in specific areas of memory, executive functions and perceptuo-motor tasks. Identification of SLDs is useful in drawing up a treatment plan specific for a particular child.