Deliberate self-harm in adolescents: A review of literature.

Deliberate self-harm is a rising epidemic in the youth. This review examined the different self-harm behavior, approach to treatment, and the implication of such behaviors in the adolescent population in the academic literature. Using the PubMed database, we searched for specific terms related to different self-harm behaviors in Adolescents. The bibliography of the articles found relevant for the review was also screened. Each study's findings were taken with reference to our topic and findings were summarized. After reviewing the literature, we found that the prevalence of suicidal attempts was as high as 18% in the past year While the nonsuicidal attempts were as high as 31%. Risk factors associated with higher levels of suicide were bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships. While the factors playing a protective role are being connected to school, having good social support, and attending school. There are very few studies focused on interventions related to suicide prevention in Adolescent and postvention programs. Out of the evidence available, the interventions are not focused on the target individuals and lack replicability. Self-harm is a major public health concern which needs to be understood holistically. The interventions aimed at preventing and managing self-harm behavior still need to be more targeted and precise. Other targets may include interventions suited to different phases of development, stopping the progression of the behavior to adulthood, including the varied population in such intervention, etc.

Evaluation of Sympathetic and Parasympathetic Tone and Reactivity in Adolescents with Specific Learning Disorder (Dyslexia).

OBJECTIVES: To evaluate the autonomic function in specific learning disorder (SLD) and comorbid SLD attention-deficit hyperactivity disorder (SLD-ADHD). METHODS: A cross-sectional study was conducted in a tertiary care hospital with 20 adolescent subjects each of confirmed SLD, SLD-ADHD, and healthy control (mean age 15.32 y). Heart-rate variability and autonomic-function tests were carried out using standard protocols. RESULTS: Heart-rate variability parameters, viz., mean RR interval, number of RR intervals which differ by ≥ 50 ms (NN50), percentage NN50, standard deviation of differences between adjacent RR intervals, root square of mean of the sum of the squares of differences between adjacent RR intervals, coefficient of variance and absolute power of high-frequency band (HF) recorded apparently lower levels in SLD and SLD-ADHD as compared to healthy control indicating lower parasympathetic tone. Whereas, higher absolute power of low- frequency band (LF) in SLD and SLD-ADHD than healthy control indicated enhanced sympathetic activity. Higher LF/HF and lower SD1/SD2 ratios in SLD and SLD-ADHD than healthy control indicated higher sympathetic tone over parasympathetic tone. Values of autonomic-function tests such as E:I ratio, change in heart rate during deep-breathing test, 30:15 ratio, and Valsalva ratio showed a decrease in SLD and SLD-ADHD as compared to healthy control implying reduction in parasympathetic reactivity. Increased values for rise in diastolic blood pressure in the isometric handgrip test and cold pressor test recorded in SLD as compared to healthy control, revealed the increased sympathetic reactivity. CONCLUSION: Overall, results of heart-rate variability and autonomic-function tests imply dysregulation of sympathetic and parasympathetic activities with sympathetic dominance in SLD and SLD-ADHD.

Self-stigma in patients with major depressive disorder: An exploratory study from India.

BACKGROUND: One of the barriers to effective care in patients with depression is stigma associated with having a mental disorder, which also acts as a barrier to recovery and increases the disability. AIMS: To study the stigma and disabilities experienced by the patients with depressive disorders seeking treatment in a tertiary care hospital. METHODOLOGY: Fifty patients diagnosed to have depressive disorder as per ICD-10 were recruited by convenient sampling. To measure the stigma, the Discrimination and Stigma Scale -12 was applied. The severity of depression was determined by applying Hamilton Depression Rating Scale (HAMD). The disability was calculated by using WHO Disability Assessment Schedule 2.0. RESULTS: Fifty percentages of the participants reported unfair treatment and they experienced discrimination in at least one life domain. There was significant positive correlation between unfair treatment subscale of stigma and disability. Around one fourth of the participants reported to be treated unfairly by their own families. Seventy percent reported to have concealed their mental health problems, 54% have stopped themselves from having a close personal relationship and 32% didn't apply for work in anticipating discrimination. Experienced and anticipated discrimination were significantly associated with concealing the mental health problem. CONCLUSION: Stigma due to having depression acts as a barrier to vocational & social integration and functional recovery. Concealment of the diagnosis of depression is itself barrier for help seeking and to receiving appropriate treatment. Small sample size and adopting the purposive sampling method are the limitations of the study.

Colossal Breed and Backlash of the 'Sesame Street': Brunt of COVID-19 Pandemic in the 'High-Tech' Era of Learning on Children and Adolescents and Suggestions.

The COVID-19 pandemic necessitated the closure of various academic institutions, leaving online learning the only option for continuity of education and curricular activities among children and adolescents. It is unclear whether the adoption of online learning will persist in the post-pandemic period. However, enhanced exposure to gadgets impacts the socio-emotive-adaptive development of young children. It sprouts various short-term as well as long-term deleterious physical and mental health effects among children and adolescents. Research has focused mainly on the epidemiology, risks modeling, pathophysiology, and clinical features of SARS-CoV-2, but the impact of increased exposure to gadgets and technology due to online learning activity and the "digital new-norm" has largely been unnoticed. The enforced/self-quarantine leading to less outdoor activities during this pandemic, may have a cumulative poor health consequence. Early detection and management of those at risk and signs and symptoms of these adverse health effects are important. Awareness regarding these ill-effects on this vulnerable group is relevant for parents, guardians, teachers, mentors, health-care providers, and policy-makers.

Psychiatric Morbidity and Behavioral Problems in Children and Adolescents with Bronchial Asthma.

OBJECTIVES: Psychiatric morbidity and behavioral problems are quite common in children and adolescents with bronchial asthma, yet they remain underexplored and often ignored in clinical settings. This can impact the child's overall quality of life. There seems to be a dearth of Indian literature and so the current study was planned to assess psychological impact of asthma on the pediatric population. METHODS: Thirty children and adolescents, attending the Pediatric Chest Clinic at a tertiary care hospital in North India in the age group of 8-15 y having moderate to severe asthma formed the study group and matched healthy controls formed the other group. Sociodemographic and clinical details were obtained. Mini International Neuropsychiatric Interview (M.I.N.I. KID) and Child Behavior Checklist (CBCL) were applied. RESULTS: Irregular attendance at school was reported by 23.33% of the participants with asthma. About 17% of the thirty study-participants were diagnosed with specific phobia, 10% with conduct disorder, and 7% with attention deficit hyperactivity disorder (ADHD). Participants in the study group had significantly more behavioral problems in the syndrome domain anxious/depressed and attention problems. Total CBCL scores were significantly higher in the study group as compared to the control group (t = 3.816, p = 0.0003), indicating the presence of more behavioral problems in pediatric population with bronchial asthma. CONCLUSION: Children and adolescents with bronchial asthma have co-morbid psychiatric morbidities and behavioral problems.

Depression among adolescents in a rural community of north India: A cross-sectional study.

BACKGROUND: There is a paucity of literature on depression among adolescents in the north Indian community. OBJECTIVES: The aim of this study was to estimate the prevalence of depression among adolescents residing in a rural community of north India, and to determine associated factors, psychiatric comorbidities, and functional impairment. METHODS: A simple random sample of 630 adolescents aged 10-19 years was drawn. Participants were enrolled in house-to-house visits, and screened for depression using the nine-item version of Patient Health Questionnaire (PHQ-9). Diagnostic confirmation and assessment of psychiatric comorbidities was done using Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) for 10-17-year-old adolescents, and MINI for 18 year olds. Prevalence was reported with 95% confidence interval. Multivariable logistic regression analysis was done to determine the association of depression with socio-demographic and other factors. Children's Global Assessment Scale (CGAS) was used to assess functional impairment. RESULTS: The prevalence of depression was 3.7% (95% CI: 2.3-5.2) (n = 583), comparable in both sexes. Over half the participants with depression had psychiatric comorbidities; the most common were conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder; nearly two-fifth had suicidal ideas/attempt. About two-third of participants with depression had functional impairment. Depression was associated with perceived frequent conflicts at home [adjusted odds ratio (aOR) = 4.0 (95% CI: 1.0-16.0), P = 0.049], and perceived stressful event (s) in past six months [aOR = 7.0 (95% CI: 2.4-20.3), P < 0.01], which were predominantly related to academics. CONCLUSION: Study results indicate the need to strengthen diagnostic and therapeutic/rehabilitative mental health services in adolescent age group. Low-stress lifestyle could be a promising approach to sidestep depressive symptoms.

Autism spectrum disorder: Trends in research exploring etiopathogenesis.

Autism spectrum disorder is a neurodevelopmental condition in which affected individuals have difficulties while interacting and communicating socially, and repetitive behaviors. It has a multifactorial etiology. Various risk factors, including genetic and environmental influences, have been explored while trying to understand its causation. As older evidence was suggestive of a high heritability, a majority of research focused on finding the underlying genetic causes of autism. Due to these efforts, there have been advances in the knowledge of some of the genetic factors associated with autism. But a recent trend also shows an increasing interest in exploration of various potential environmental triggers. These efforts have brought us closer to understanding the elusive disorder more so than ever before. The current review discusses the recent trends in research exploring the etiopathogenesis of autism spectrum disorder.

Trends in concept and nosology of autism spectrum disorder: A review.

Autism Spectrum Disorder is a neurodevelopmental disorder characterized by persistent deficits in social communication, social interaction and restricted, repetitive patterns of behavior, interests or activities. The concept of autism has changed since its inception, from childhood schizophrenia to neuro-variation. These changes in concept have been accompanied by changes in the diagnostic threshold through which the 'case' of autism is identified. The occurrence of multiple changes in its diagnostic criteria over last 80 odd years opens up the possibility of challenges being posed to the existence of the disorder as it is today, with a possibility of newer conceptualization of autism coming up in the future. The potential consequences of the changes in its nosology and concept, such as those on the management and on prevalence estimation are some of the essential issues which need attention. In the current paper, we evaluate the evolution of the concept and nosology of autism with an overview of the accompanying impact of these changes.

A controlled study of plasma fatty acids in Indian patients with depressive episode.

AIM: To study the plasma omega 3 and omega 6 fatty acid levels in patients with depressive episode and in matched healthy controls. METHOD: Thirty patients with first episode depression and thirty healthy matched control subjects were recruited from a tertiary care hospital setting. We measured plasma omega-3 and omega-6 fatty acid levels of the study and the control group. RESULT: There were no significant differences in plasma omega 3 fatty acid levels between study group and control group. The plasma omega 6 fatty acid levels of study group were significantly less than that of control group. CONCLUSIONS: The present study is an initial attempt to investigate the link between fatty acids and depression in a clinical setting in India. This comparative study with normal controls did not etiologically link these polyunsaturated fatty acids in this sample of depressive disorder.

Successful Long-term Management of a Child with Kleine-Levin Syndrome with Low-dose Lithium.

Kleine-Levin syndrome (KLS) is a rare disorder characterized by episodic hypersomnia along with cognitive and behavioral disturbances (i.e., hyperphagia and hypersexuality). It is commonly seen in a young male. Not much is known about its long-term management; however, many reports suggest the usefulness of anticonvulsants and lithium for the same. We hereby report a case of childhood KLS from India who was successfully treated with low-dose lithium and discuss the relevant literature.

Erratum to: Prevalence of child and adolescent psychiatric disorders in India: a systematic review and meta-analysis.

[This corrects the article DOI: 10.1186/1753-2000-8-22.].

Initial treatment dropout in patients with substance use disorders attending a tertiary care de-addiction centre in north India.

BACKGROUND & OBJECTIVES: Dropout from substance use disorders treatment is associated with poor outcomes. Although many factors have been associated with an early dropout of patients, the reasons for dropping out of treatment prematurely remain poorly understood particularly in the Indian context. This study was aimed to study socio-demographic and clinical variables predicting initial dropout of patients attending a tertiary care de-addiction treatment centre in north India. METHODS: Information was extracted from the records of consecutive newly registered patients from January 2011 to December 2014. The patients who did not come for follow up within 30 days of the first contact were defined as initial dropouts. RESULTS: Data of 7991 patients could be retrieved. Majority of the sample consisted of male, married and employed individuals. Of them, 4907 patients (61.3%) were considered initial dropouts. Multivariate analysis revealed that after controlling for other factors, greater age, being employed, lower educational status, lesser duration of substance use, use of alcohol, opiate, tobacco, cannabis or sedative-hypnotic use but the absence of multi-substance use predicted initial drop out. INTERPRETATION & CONCLUSIONS: This study identified some socio-demographic and clinical variables which might predict treatment attrition in substance use disorders. Clinician's awareness towards these factors and tailor-made intervention might improve initial treatment retention. Future research could be directed to find the validity of this assumption.

Predictors of retention in treatment in a tertiary care de-addiction center.

CONTEXT: Retention in treatment can improve the outcomes of patients with substance use disorders. AIMS: This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders. SETTING AND DESIGN: This record-based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in Northern India. MATERIALS AND METHODS: Patients were classified as being retained in treatment or drop-outs based on follow-up records. STATISTICAL ANALYSIS: Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment. RESULTS: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10(th) grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance-related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention. CONCLUSION: Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.

Pituitary Macroadenoma Presenting with Multiple Psychiatric Complications.

We report a case of pituitary macroadenoma with multiple physical and psychiatric complications, which posed a significant diagnostic dilemma and management challenge for the treating teams of neurosurgery, endocrinology and psychiatry. A pragmatic approach comprising of interdisciplinary collaboration resulted in satisfactory management of the case.

Prevalence of child and adolescent psychiatric disorders in India: a systematic review and meta-analysis.

BACKGROUND: The importance of epidemiological studies lies in recognition of cases that do not come to treatment settings. The increasing focus on child adolescent mental health in India points to the necessity of epidemiological studies on children. Although there are a few such studies done in different parts of India in different socio-cultural settings, data from those cannot be generalized to the entire country. This need can be served by meta-analysis. There has been no meta-analysis reported from India for the child and adolescent psychiatric epidemiology. AIM: To review and do the meta-analysis of epidemiological studies on child and adolescent psychiatric disorder from India. METHODS: Sixteen community based studies on 14594 children and adolescents; and seven school based studies on 5687 children and adolescents, reporting prevalence of child and adolescent psychiatric disorder were analyzed and overall prevalence was calculated. RESULTS: The prevalence rate of child and adolescent psychiatric disorders in the community has been found to be 6.46% (95% confidence interval 6.08% - 6.88%) and in the school it has been found to be 23.33% (95% confidence interval 22.25% - 24.45%). CONCLUSIONS: This is the first meta-analysis determining the epidemiology of child and adolescent psychiatric disorders in India. It has been found that the reporting systems of psychiatric disorders in children are inadequate.

A controlled study of serum lipid profiles in Indian patients with depressive episode.

BACKGROUND: Lower levels of circulating lipid fractions and cholesterol are risk factors for impulsivity and depressive disorder. A lower level of serum cholesterol is also associated with patients presenting with history of self-harm. MATERIALS AND METHODS: A total of 30 depressive patients and 30 healthy matched control subjects were recruited from the department of Psychiatry of a tertiary care hospital. We measured serum total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein cholesterol and triglyceride levels of both patient and control group. RESULTS: The serum TC and LDL-cholesterol levels were found to be significantly lower in study group than that of control group. CONCLUSION: Lower levels of serum cholesterol are associated with depressive disorder.

Complicated alcohol withdrawal presenting as self mutilation.

Self-mutilation has been defined as deliberate self injury to body tissue without the intent to die. There has been an association between substance abuse and self mutilation. Alcoholic hallucinosis is usually in auditory modality and regarded as harmless. But patients can indulge in self harm behavior when the hallucinosis is commanding type. We are presenting a case in which the patient inflicted multiple stab injury to his own abdomen in response to alcoholic hallucinosis. This has clinical implication to enquire about substance abuse in patients presenting to emergency setting.