Internet Addiction and Its Association with Demographic Variables, Depression, Anxiety, and Psychological Well-being in College Students.

Background: Internet is an integral part of the daily life of everyone. Internet addiction (IA) is one of the major concerns, specifically among young adults. The association between IA, depression, anxiety, and psychological well-being (PWB) is least studied in young adults. Purpose: To evaluate IA and its association with psychological morbidity and PWB in a larger sample size. In addition, to examine the factors that are associated with IA. Methods: A total of 1287 young students were evaluated in the present study. Participants were evaluated on the Internet Addiction Test (IAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Psychological Well-Being Index-22. Results: The mean age of the study's participants is 19.5 years. The majority were female (68.9%), from nuclear families (61.8%), and belonged to urban localities (61.5%). On IAT, 15.9% had a presence of IA with a cut-off score of 50. 27.4% and 20.5% had a presence of depression and anxiety with a cut-off score of 10 on the PHQ-9 and GAD-7, respectively. Approximately two-thirds (66.7%) reported poor PWB. IA had a significant positive association with depression and anxiety and a negative association with PWB. Male students, the presence of depression, anxiety, and poor PWB were independent factors associated with IA. Conclusion: Internet addiction is highly prevalent among college students and has a significant association with anxiety, depression, and poor PWB. There is a need to develop a structured plan, educational strategy, and program to minimize IA in young adults.

Prevalence and sociodemographic determinants of common mental disorders (CMDs) symptoms in a rural adult population of Haryana, North India.

Objectives: Common mental disorders (CMDs), including depression, anxiety, and somatoform disorders, affect all stages of life and impact individuals, families, and communities. This study aimed to determine the magnitude of CMDs and their sociodemographic determinants in the adult population of a rural block in North India. Material and Methods: A cross-sectional, quantitative, community-based study was conducted among adult residents of a rural block in Haryana, North India, using a multistage random sampling technique. The Hindi version of the General Health Questionnaire (GHQ-12), a well-validated tool, was used to screen participants for CMDs. Scores of 4 or above denoted the presence of CMDs. Bivariate analyses were performed to determine the associations between CMDs and sociodemographic characteristics. Results: Of the 180 residents selected for the study, most were women (60.0%) and aged between 31 and 50 years (52.3%). The prevalence of CMDs symptoms in the study population was 20.0%. The presence of CMDs symptoms was significantly higher among those who were aged 60 years or older [OR=12.33, 95% CI 3.21-47.38], widowed, divorced or separated [OR=7.50, 95% CI 1.09-51.52], illiterate [OR= 6.25, 95% CI 2.84-13.77], had monthly family income below 10,000 INR [OR=3.33, 95% CI 1.54-7.20], had any chronic physical illness [OR=8.28, 95% CI 3.70-18.56] and had a family history of any psychiatric illness [OR=5.56, 95% CI 1.52-19.42]. Conclusion: The burden of CMDs was quite high among adults in rural North India. The presence of CMDs was closely associated with sociodemographic characteristics. Primary care and community-based settings need to screen for, diagnose, and manage CMDs to address this growing problem.

Longitudinal Experience and Determinants for Common Mental Health Problems, Phantom Limb and Functional Outcome in Lower Limb Amputees.

Background: Amputation of a limb is equivalent to loss of a person's life. Psychological aspects are essential factors in dealing with the disability and functional outcome is a significant concern. Longitudinal studies have not examined the experience and determinants of common mental health problems and functional outcome in lower limb amputees. Materials and Methodology: A total of 103 lower limb amputees were recruited and followed up for 6  months. Patients were assessed on Hospital Anxiety and Depression Scale (HADS) and Social Functioning (SF-36) Quality of life, semi-structured clinical interview for psychiatric disorders and phantom limb at baseline (in hospital), at 2 weeks, 3 months and 6 months, respectively after discharge. Holistic care was provided through psychological counselling, supportive sessions, medications if required, rehabilitation counselling, prosthesis implantation, and treatment as usual. Results: Holistic care resulted in a statistically significant reduction in anxiety, depression and overall psychiatric morbidity as measured on HADS (p < 0.001). There was a significant improvement in all the domains of SF-36 (p -< 0.001) except the role of limitation due to physical activity. The intervention also resulted in a statistically significant reduction in the presence of phantom limbs. Conclusion: Amputees should be provided holistic care under one roof, which was found to be very useful in treating psychiatric morbidity, social functioning and quality of life.

Experience of patients and their caregivers with telepsychiatry consultations: An exploratory study.

Background: While telepsychiatry became a prominent and widely used service in the COVID-19 pandemic-related lockdown, data regarding the patient's experience of telepsychiatry consultations is lacking. Materials and Methods: In this study, we attempted to understand the experience and level of satisfaction of 129 patients receiving psychiatry consultations over video consultations from April 2021 to December 2021. We also tried to understand the factors that might be associated with the satisfaction of the patients. Results: About three-fourths (77.5%) of the respondents were very satisfied with the quality of care provided and the overall experience of the consultation. The majority (92.2%) of the respondents reported that they would "definitely" recommend the telepsychiatry service to a friend or relative in need of a psychiatric consultation. The majority of the patients expressed high levels of satisfaction with the amount of time spent, the amount of freedom in expressing themselves, the amount of freedom in choosing the treatment option, the prescription provided, and the number of medications prescribed. The clarity of voice and the quality of connectivity throughout the consultation were found to be associated with the level of satisfaction. Conclusions: The present study suggests that overall satisfaction with teleconsultations was high among patients and/or caregivers for telepsychiatry consultations.

Prevalence of mixed features in patients with first-episode depression: An exploratory multicentric study.

Background and Aim: There is limited literature on the prevalence of mixed features in patients with depression, especially from countries in Asia. Our aim was to evaluate the prevalence of "mixed features" in patients with first-episode depression. Materials and Methods: Patients with first-episode depression were evaluated for the presence of mixed features as per the Diagnostic and Statistical Manual (DSM)-5 criteria. They were additionally evaluated on Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Results: About one-sixth (16%) of the patients fulfilled the DSM-5 criteria for the mixed features specifier. The most common manic/hypomanic clinical feature was increased talkativeness or pressure of speech, followed by elevated expansive mood (12.5%), and inflated self-esteem or grandiosity was the least common feature (8.7%). Those with mixed features had higher prevalence of comorbid tobacco dependence and psychotic symptoms. In terms of frequency of depressive symptoms as assessed on HDRS, compared to those without mixed features, those with mixed features had higher frequency of symptoms such as depressed mood, insomnia during early hours of morning, work and activities, agitation, gastrointestinal somatic symptoms, genital symptoms, hypochondriasis, and poorer insight. Conclusion: Mixed features specifier criteria were fulfilled by 16% patients with first-episode depression. This finding suggests that the extension of this specifier to depression can be considered as a useful step in understanding the symptom profile of patients with depression.

Indian Psychiatric Society multicentre study: Diagnostic patterns, comorbidity and prescription practices for patients with Dementia.

Background: There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle. Aim: This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India. Method: A retrospective case file study was conducted across several centers in India. Results: Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer's disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions. Conclusions: Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided.

Sensory Deprivation and Psychiatric Disorders: Association, Assessment and Management Strategies.

Background: Sensory deprivation (SD) is a widely prevalent condition that leads to various health-related consequences and is also an important cause of disability worldwide. Earlier, SD experiments were used as research modalities to alter human behavior. In recent years, the focus has shifted to understand how SD can affect the mental health of individuals (with congenital or acquired sensory impairments). This narrative review focuses on the current understanding about the association of SD and psychiatric disorders. Methods: A comprehensive literature search was done PubMed, Scopus, PsycINFO, and Google Scholar and in the cross-references of relevant articles. Keywords included "sensory deprivation," "blindness," "deafness," "mental illness," "psychiatric disorders," "prevalence," "assessment," and "management" in various combinations. Only original articles (abstract and full text) published in English till October 2020 were included. Results: The prevalence of anxiety, depression, dementia, suicidality, and psychosis in persons with SD is higher than the general population (highest being in persons with dementia with comorbid SD). Several mechanisms/hypotheses have been proposed to explain these associations. Assessment of SD includes a thorough history taking, with adequate awareness about the difficulties faced during a psychiatric interview in this population. Modifications in the psychometric assessment procedures are warranted. Management depends on a multi-disciplinary approach that includes proper referral to specialties, pharmacological management (depending on diagnosis as well as taking care of ototoxic/ocular side-effect profile of the drugs), and nonpharmacological supportive measures. Conclusions: SD is a complex condition, and evidence suggests that persons with SD have higher psychiatric morbidity. A comprehensive assessment, along with holistic management approach is warranted.

A multicentric exploratory study of behavioral and psychological symptom characteristics of dementia.

Background: Behavioral and psychological symptoms (BPS) are usually the expected consequences of dementia. BPS increases morbidity and burden, affects the quality of life, and impacts care costs. However, the symptom characteristics, clinical correlations, and symptom-specific clusters aiding the diagnosis are less well studied, especially in the Indian population. Materials and Methods: The present study examined the BPS clusters based on various cognitive and neuropsychiatric profiles in patients with dementia under a multicentric study in India. We did a cross-sectional assessment using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and cognitive functions by Montreal Cognitive Assessment (MoCA), and the severity of dementia using the Clinical Dementia Rating (CDR) scale. In addition, all of the participants were evaluated on a structured Clinical Interview for DSM-5 Research Version for past or current psychiatric disorder(s). Results: We describe the various BPS clusters uniquely associated with the severity of dementia. Further, on linear regression analysis, we predicted three symptom clusters (anxiety, irritability, aberrant motor) in mild, two symptom clusters (disinhibition, agitation/aggression) in moderate and three symptom clusters (delusion, euphoria/elation, disinhibition) in severe dementia. Conclusion: The study provides insights into the various symptom characteristics and inter-relationship of BPS, which may benefit the clinician while assessing patients with dementia.

Current telepsychiatry practice in India - An online survey of psychiatrists.

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.

Cognitive Deficits in Patients with COVID-19 Infection during Their Hospital Stay: An Exploratory Study.

Background The literature on presence of cognitive deficits in patients recovered from coronavirus disease 2019 (COVID-19) infection is emerging. However, the data on whether cognitive deficits have its onset during the acute phase of illness has not been evaluated extensively. Aim This article estimates the level of cognitive functioning of patients with COVID-19 while they were admitted to COVID-designated wards. Secondary objectives were to assess the influence of medical comorbidities, severity of COVID-19 infection, and depressive and anxiety symptoms on cognitive functioning in patients with COVID-19 infection. Methods Sixty-six clinically stable patients with COVID-19 infection were evaluated during their inpatient stay on Hindi Montreal Cognitive Assessment scale (H-MoCA), Hindi Mini-Mental State Examination (HMSE) scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Questionnaire -7. Results The mean age of the study participants was 39.85 (standard deviation [SD] 16.89) years and the participants were evaluated after 9.34 (SD 4.98; median 9.0) days of being diagnosed with COVID-19 infection. About one-fourth (28.8%; n = 19) of the participants had cognitive impairment on HMSE and about two-fifths ( n = 26; 39.39%) had cognitive impairment as per the cutoff used for H-MoCA. A higher level of cognitive deficits were seen among participants who were older, diagnosed with diabetes mellitus, and those who required oxygen support during their hospital stay prior to assessment. Conclusion Low cognitive score was found in one-fourth (28.8%) to two-fifths (39.9%) of the persons, depending on the assessment scale among those with acute COVID-19 infection. Low cognitive score was more prevalent among the elderly, those with diabetes mellitus, and those who required oxygen support prior to the assessment.

Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units.

Background: The coronavirus disease-2019 (COVID-19) pandemic has led to a significant disruption in healthcare delivery and poses a unique long-term stressor among frontline nurses. Hence, the investigators planned to explore the adverse mental health outcomes and the resilience of frontline nurses caring for COVID-19 patients admitted in intensive care units (ICUs). Materials and methods: A cross-sectional online survey using Google form consisted of questionnaires on perceived stress scale (PSS-10), generalized anxiety disorder scale (GAD-7), Fear Scale for Healthcare Professionals regarding the COVID-19 pandemic, insomnia severity index, and the Connor-Davidson Resilience Scale-10 (CD-RISC) were administered among the nurses working in COVID ICUs of a tertiary care center in North India. Results: A considerable number of subjects in the study reported symptoms of distress (68.5%), anxiety (54.7%), fear (44%), and insomnia (31%). Resilience among the frontline nurses demonstrated a moderate to a high level with a mean percentage score of 77.5 (31.23 ± 4.68). A negative correlation was found between resilience and adverse mental outcomes; hence, resilience is a reliable tool to mitigate the adverse psychological consequences of the COVID-19 pandemic. Conclusion: Emphasizing the well-being of the nurses caring for critical COVID-19 patients during the pandemic is necessary to enable them to provide high-quality nursing care. How to cite this article: Jose S, Cyriac MC, Dhandapani M, Mehra A, Sharma N. Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2022;26(2):174-178.

Suicidal behavior in new patients presenting to the Telepsychiatry services in a Tertiary Care center: An exploratory study.

BACKGROUND: The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. AIM: To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre. METHODS: 1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). RESULTS: In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management. CONCLUSIONS: Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.

Association of serum BDNF level and Val66Met polymorphism with response to treatment in patients of major depressive disease: A step towards personalized therapy.

BACKGROUND: Major depressive disorder (MDD) is one of the most common psychiatric disorders and only less than 50% of MDD patients achieve remission after the first antidepressant trial. Hence, it is important to understand the factors associated with response to various antidepressant medications. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family. BDNF and Val66Met polymorphism in the BDNF gene has a role in MDD. This study aimed to determine the association of rs6265 polymorphism and serum BDNF level with response to treatment in MDD patients. METHODS: The study included 200 subjects, consisting of 100 MDD patients treated with oral antidepressants and 50 treated with ECT, and 50 healthy controls. Serum BDNF levels were estimated using ELISA and rs6265 polymorphism was genotyped using tetra-primer ARMS PCR. RESULTS: Val66Met polymorphism had an association with MDD, and in MDD patients with Met allele was associated with a better response to antidepressants. Serum BDNF level was significantly higher in MDD patients compared to healthy individuals. In MDD patients, lower serum BDNF level was associated with better ECT outcomes. CONCLUSIONS: Val66Met polymorphism in BDNF gene and serum BDNF level has the potential to be used as a biomarker for the prediction of response to oral antidepressants and ECT in MDD patients. The presence of the Met allele might be used to predict the chances of occurrence of MDD in the future. The results of our study might form a basis for the development of personalized treatment for MDD in the future.

The prescriptions of psychotropic medications in telepsychiatry: An online survey of psychiatrists in India.

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.

Perceived advantages and disadvantages of telepsychiatry - An online survey of psychiatrists in India.

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.