Substance use and its associated factors among school students.

Background: . There is lack of comprehensive data on substance use and associated factors among school students in Delhi, India. Methods: . We used a cluster sampling method based on sections of classes in schools to conduct this study in two government-run schools in Delhi. All enrolled students from 8th, 9th and 11th grades participated (n = 405). The WHO Student Drug Use questionnaire was administered in a single session for a class section for assessing substance use. Results: . The participation rate was 90.6%. The rates of past 12 months' use of tobacco, alcohol, cannabis and inhalants were 22%, 12.1%, 12.1% and 8.6%, respectively, while rates for 'sedatives and tranquillizers' were 4.9%, opium 2.7% and other opioids 1.2%. Lifetime use of heroin was reported by two students and use in the past 12 months by one student. Multiple substance use was high. Higher age was associated with the use of alcohol and cannabis. According to logistic regression model results, use by a family member significantly increased the probability of using tobacco (adjusted odds ratio [AOR] 11.3; 95% confidence interval (CI) 3.4-37.8) and alcohol (AOR 3.75; 95% CI 5.1-1059.3). Similarly, use by peers significantly increased the probability of tobacco (AOR 7.7; 95% CI 2.0-29.8) and cannabis use (AOR 5.7; 95% CI 1.5-21.5). Having poor harm perception significantly increased the chances of inhalant use by students (AOR 5.5; 95% CI 1.5-20.1). Conclusion: . The study results bring to attention the prevalent and important problem of substance use among schoolchildren. We recommend that (i) intervention strategies for school settings are important and need to factor in the use of illicit substances (cannabis); (ii) psychosocial intervention by trained school counsellors in school settings is the mainstay for intervention for cannabis and inhalants; and (iii) heroin users should be referred to healthcare facilities for detoxification.

Rapid Eye Movement (REM) Sleep Behavior Disorder and REM Sleep with Atonia in the Young.

BACKGROUND: Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) have assumed much clinical importance with long-term data showing progression into neurodegenerative conditions among older adults. However, much less is known about RBD and RWA in younger populations. This study aims at comparing clinical and polysomnographic (PSG) characteristics of young patients presenting with RBD, young patients with other neurological conditions, and normal age-matched subjects. METHODS: A retrospective chart review was carried out for consecutive young patients (<25 years) presenting with clinical features of RBD; and data were compared to data from patients with epilepsy, attention deficit hyperactivity disorder (ADHD), and autism, as well as normal subjects who underwent PSG during a 2-year-period. RESULTS: Twelve patients fulfilling RBD diagnostic criteria, 22 autism patients, 10 with ADHD, 30 with epilepsy, and 14 normal subjects were included. Eight patients with autism (30%), three with ADHD (30%), one with epilepsy (3.3%), and six patients who had presented with RBD like symptoms (50%) had abnormal movements and behaviors during REM sleep. Excessive transient muscle activity and/or sustained muscle activity during REM epochs was found in all patients who had presented with RBD, in 16/22 (72%) autistic patients, 6/10 (60%) ADHD patients compared to only 6/30 (20%) patients with epilepsy and in none of the normal subjects. CONCLUSION: We observed that a large percentage of young patients with autism and ADHD and some with epilepsy demonstrate loss of REM-associated atonia and some RBD-like behaviors on polysomnography similar to young patients presenting with RBD.

Troubles du comportement en sommeil paradoxal et sommeil paradoxal sans atonie musculaire chez les jeunes. Contexte: Les troubles du comportement en sommeil paradoxal (TCSP) et le sommeil paradoxal sans atonie musculaire ont acquis une grande importance clinique. En effet, des données à long terme ont montré de quelle façon ils pouvaient progresser chez des adultes âgés atteints de maladies neurodégénératives. Toutefois, on en sait beaucoup moins au sujet des TCSP et du sommeil paradoxal sans atonie musculaire au sein des groupes d'âges plus jeunes. Cette étude entend donc comparer les caractéristiques cliniques et polysomnographiques (PSG) de jeunes patients donnant à voir des signes de TCSP à celles d'autres jeunes patients atteints d'autres troubles neurologiques et de sujets en bonne santé appariés en fonction de l'âge. Méthodes: Nous avons passé en revue de façon rétrospective les dossiers de jeunes patients (< 25 ans) donnant à voir des signes cliniques de TCSP et ayant été vus consécutivement. Les données recueillies ont été comparées aux données de patients atteints d'épilepsie, de troubles de l'attention avec hyperactivité et d'autisme ainsi qu'à celles de sujets en bonne santé soumis à des examens de PSG pendant une période de deux ans. Résultats: Au total, on a diagnostiqué chez 12 patients des TCSP. Ajoutons que 22 d'entre eux étaient atteints d'autisme alors que 10 étaient atteints de troubles de l'attention avec hyperactivité et 30 d'épilepsie. Mentionnons par ailleurs que 14 sujets en bonne santé ont été inclus dans cette étude. Après analyse, il s'est avéré que 8 patients atteints d'autisme (30 %), 3 de troubles de l'attention avec hyperactivité (30 %), 1 d'épilepsie (3,3 %) et 6 ayant donné à voir des symptômes ressemblant à ceux des TCSP (50 %) montraient des mouvements et des comportement anormaux en sommeil paradoxal. Des signes d'activité musculaire transitoire excessive et/ou d'activité musculaire durable lors d'épisodes de sommeil paradoxal ont été détectés chez tous les patients satisfaisant aux critères des TCSP, chez 16 patients autistes sur 22 (72 %), chez 6 patients atteint de troubles de l'attention avec hyperactivité sur 10 (60 %) en comparaison avec seulement 6 patients épileptiques sur 30 (20 %) et aucun parmi les sujets en bonne santé. Conclusion: Lors d'examens polysomnographiques, nous avons en définitive observé qu'une forte proportion de jeunes patients atteints d'autisme et de troubles de l'attention avec hyperactivité, ainsi que quelques-uns atteints d'épilepsie, donnaient à voir des signes de perte de sommeil paradoxal associés à l'atonie musculaire ainsi que des comportements ressemblant à ceux de jeunes patients atteints de TCSP.

Assessment for familial pattern and association of polymorphisms in KIAA0319 gene with specific reading disorder in children from North India visiting a tertiary care centre: A case-control study.

Genetic association studies have identified KIAA0319 gene as a possible susceptibility locus for reading disorder; however, very few studies are available from India. The study was planned to investigate the familial pattern and association of KIAA0319 polymorphisms among children with reading disorder visiting a tertiary centre in North India. This is a case-control, familial, and genetic association study on 30 children diagnosed with reading disorder (ICD-10) and 30 matched healthy controls and their families. The Aggregate Neurobehavioral Student Health and Educational Review System was administered on parents of probands and controls for reading problems in their siblings, and Adult Reading Questionnaire was administered for parents of both groups. The blood sample was taken from probands, and DNA was isolated. Four KIAA0319 coding sequence single nucleotide polymorphisms (SNPs; rs4504469, rs6935076, rs2038137, and rs2179515) were genotyped using SNaPshot single nucleotide extension. The incidence of reading problem was significantly higher in families of probands as compared with families of controls. There were no significant differences in both groups regarding the frequency of alleles of four SNPs. The reading disorder showed a significant familial pattern, but KIAA0319 gene did not appear to be a susceptibility factor. Future replications with larger samples and whole genome studies are warranted.

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.

Gender Issues and Related Social Stigma Affecting Patients with a Disorder of Sex Development in India.

Children with disorders of sex development (DSD) manifest at birth with malformed genitalia or later with atypical pubertal development. Those born with malformed genitalia are often diagnosed at birth. However, in resource-poor countries like India, where not all births are supervised by healthcare workers, some of these children remain undiagnosed until puberty or even later. The aim of this study was to assess the gender issues and psychosocial problems of children with DSD. Participants included 205 children with DSD (103 with 46,XX DSD and 102 with 46,XY DSD). Both the children with DSD and their parents underwent semistructured interviews by a clinical psychologist. The birth of a child with DSD was perceived as a major medical and social problem by parents from all socioeconomic strata. Mothers were distressed as many believed the DSD condition was transmitted through the mother. Children who were not diagnosed and treated during infancy or early childhood experienced considerable social discrimination not only from relatives and friends but also from medical and paramedical staff in hospitals. Several patients had been operated during infancy without an etiological diagnosis and without provision of adequate information to the parents. Some children had problems related to complications of surgery. Most teenage patients with 5α-reductase-2 deficiency reared as females presented with gender dysphoria, while children with androgen insensitivity (except for one) or with gonadal dysgenesis developed a gender identity concordant with their gender of rearing. Parents of children with DSD preferred a male gender assignment for their children (if that was possible) because of the social advantages of growing up male in a patriarchal society.

Age and gender might influence big five factors of personality: a preliminary report in Indian population.

Age and gender are two important physiological variables which might influence the personality of an individual. The influence of age and gender on big five personality domains in Indian population was assessed in this cross-sectional study that included 155 subjects (female = 76, male = 79) aged from 16-75 years. Big five personality factors were evaluated using 60-item NEO-Five Factor Inventory (NEO-FFI) at a single point in time. Among the big five factors of personality, Conscientiousness was positively correlated (r = 0.195; P < 0.05) with age in total study population, and retained the significance (P < 0.05) in men only when analyzed by gender subgroups. Further, age and gender sub-group analysis also showed that Neuroticism was inversely correlated with age in women aged 26-35 years (P < 0.05). Neuroticism and Extraversion showed a positive correlation with age in men aged 36-45 years (P < 0.001 and P < 0.05, respectively). Neuroticism was inversely correlated with age in men aged 46-55 years (P < 0.05). This preliminary report suggested that personality traits might change with age, and is gender-dependent.

Psychotherapeutic intervention in somatisation disorder: results of a controlled study from India.

Somatisation disorder is a chronic condition often associated with poor response to treatment, troublesome symptoms, distress, disability and burden. Psychosocial interventions have an important role to play in treatment. However, there is a lack of controlled studies especially from the non-western world. The present study assessed the efficacy of non-pharmacological interventions in somatisation disorder using a case control design. Fifteen patients each diagnosed as somatisation disorder as per ICD DCR criteria received six sessions of a specific psychological intervention (designed specifically for the study) or a non-specific psychological intervention along with fluoxetine. The subjects were followed up for 8 weeks. Assessments were carried out at 0, 4 and 8 weeks using structured measures. Mean age of the sample was 33 ± 7.11 years. Both the groups suffered moderate level of depression, anxiety and disability, and high neuroticism and subjective distress as measured on different instruments. A significant improvement was observed in both the groups in all the measures following the intervention. The group receiving the specific interventions showed more improvement. The study concludes that both specific as well as non specific psychotherapeutic interventions can bring substantial improvement in patients with somatisation disorder, with more improvement seen with specific psychotherapeutic interventions.

Randomized Controlled Trial in Advance Stage Breast Cancer Patients for the Effectiveness on Stress Marker and Pain through Sudarshan Kriya and Pranayam.

OBJECTIVE: The objective of this study is to examine the effect of a cognitive, behavioral stress management module of Sudarshan Kriya (SK) and P on levels of serum cortisol and pain among the women suffering from advanced stage breast cancer. MATERIALS AND METHODS: Participants (n = 147) were screened and randomized to receive standard care (n = 69) versus standard along with SK and Pranayam (P) intervention (n = 78) imparted in one 18 hrs workshop spread during 3 days. Participants were expected to practice it at home 20 min daily as adjuvant to standard pharmacological treatment for pain. RESULTS: There was a significant difference in blood cortisol levels after 3 months of practice of SK and P. Mean blood levels in the intervention arm were 341.2 ng/ml against 549.2 ng/ml in the control arm (P ≤ 0.002). Pain perception in comparison to control arm reduced by 3 points in SK and P arm on 0-10 verbal scale of pain. CONCLUSION: SK and P is an effective intervention in reducing stress and pain among advance stage patients of breast cancer.

Neuropsychological performance in euthymic Indian patients with bipolar disorder type I: correlation between quality of life and global functioning.

AIM: This study aims to assess the neuropsychological performance, quality of life (QoL) and global functioning in euthymic patients and healthy controls. It also explores the hypothesis that poorer cognitive performance will adversely influence the QoL of patients with bipolar disorder. METHODS: We carried out a cross-sectional assessment of 30 euthymic patients with bipolar disorder type I and compared them to a healthy control group. All the participants were evaluated for IQ, sustained attention, information processing speed, executive functions and memory using the Verbal Adult Intelligence Scale, the Trail Making Test A & B, the Stroop Color and Word Test, the N-Back test and Postgraduate Institute Memory Scale. Patients were also rated on World Health Organization QoL (BREF, Hindi version) and Global Assessment of Functioning. RESULTS: The patient and control group were comparable in age, sex distribution, education, and verbal IQ. Compared to controls, the patients performed poorly on tests for sustained attention, information processing speed, cognitive flexibility, delayed recall and verbal retention. Patients had significantly lower scores in psychological and social domains of QoL as well as global functioning. The test for sustained attention, executive functions and verbal retention showed a significant correlation to QoL domains. On stepwise multiple regression, cognitive flexibility and set shifting (Trail Making Test Part B) could significantly predict the psychological and social QoL domains, explaining 17% and 32% of the variance, respectively. CONCLUSION: Patients with bipolar disorder display cognitive impairments in the euthymic period, which appears to adversely affect their QoL and overall functioning.

Effectiveness of Metacognitive Therapy in Patients With Depression and Comorbid Anxiety Symptoms: A Case Series From India.

Metacognitive therapy (MCT) is a transdiagnostic intervention used to treat different psychiatric disorders. This intervention is based on the concept that persistent emotional distress is a consequence of a particular way of responding to negative thoughts and emotions. MCT for depression and anxiety aims at targeting rumination, worry, and the dysfunctional metacognitive beliefs underlying these thought processes. The purpose of this study was to explore MCT as a treatment for adult patients with depression (either major depressive disorder (MDD) or recurrent depressive disorder, dysthymia, or mixed anxiety depressive disorder) with comorbid anxiety symptoms. Four men diagnosed with depressive disorder with comorbid anxiety symptoms seeking treatment from the outpatient clinic of the Department of Psychiatry at the All India Institute of Medical Sciences, New Delhi, were recruited for the study. Each patient received 10 individual weekly sessions of MCT, lasting up to 1 hour each. Participants were assessed at baseline, post-intervention (right after completing MCT), and at one-month and two-month follow-ups. Primary outcome measures were a reduction in the severity of depression, anxiety, worry, and rumination. Secondary outcome measures were changes in dysfunctional metacognitive beliefs about worry and rumination. All outcomes were assessed via self-report using standardized questionnaires at baseline, post-intervention, one-month, and two-month follow-up. Data for all the outcome measures (at baseline, post-intervention, one month, and two-month follow-up) were plotted on a graph for visual examination. Additionally, we calculated clinically significant change (≥50% reduction in symptom severity and one other standardized criteria for clinically significant changes) for all the primary outcome measures across the above-mentioned four time points. All four men were single, well-educated, and had a mean age of 25.5±4.79 years. Their mean illness duration was 21±0.64 months. None of them had ever received any psychotherapy for their current illness. They had severe depressive and anxiety symptoms at baseline. Three participants had high scores on the rumination and worry scales. At post-intervention, all the participants had significant improvement on all the primary outcome measures, and they maintained their gains on follow-up assessments. Our study generated preliminary evidence supporting the effectiveness of MCT in treating depressive disorders with comorbid anxiety symptoms in the Indian context.

The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders.

Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.

Development of Home-Based Intervention Module for Specific Learning Disorder Mixed Type: A Qualitative Study.

Background: Despite significant prevalence of specific learning disorder (SLD) in India, insufficient efforts have been taken to deal with its burden. Currently, the workforce is limited and resources are expensive and difficult for families to access. Consequently, developing an alternative remedial program in the form of a home-based intervention (HBI) is imperative. This article describes the development phase of a manualized HBI program for 7 to 12-year-old children with SLD. Methods: Extensive literature search, 7 focus group discussions with parents of children with and without SLD and teachers/counselors (n = 44), and 22 in-depth interviews with SLD children (n = 9) and professionals (n = 13) were conducted. A thematic analysis was done. Intervention strategies were identified based on themes. Experts' feedback about the content and structure of HBI was also taken. Results: The design and application of the HBI program integrate several intervention areas, including psychoeducation, learning strategies, cognitive, social, and behavioral techniques, and therapy for parents. HBI comprised 14 parent training sessions, the duration being 45 to 60 min per session, over six months. Parent training consisted of four steps. (a) The researcher/clinician describes the steps of reading, writing, or math strategies to the parents/caregivers; (b) the researcher/clinician implements the strategies with or without the presence of the child and observation by the parent; (c) the parent practices the strategies in front of the researcher/clinician; and (d) the researcher/clinician observes parents' practice and corrects them if required. Conclusion: HBI manual for children with SLD-mixed type has been developed, keeping with all stakeholders' perspectives. Further study is on the way to assess its acceptability, feasibility, and effectiveness.

A Cross-Sectional Comparative Study of Sleep Disturbances in Children with ADHD and Matched Controls.

Background: Systematic reviews conducted on sleep disturbances in attention deficit hyperactivity disorder (ADHD) have found inconsistent results due to the presence of several moderating variables which were not controlled for in previous studies. The aim of this study was to examine sleep disturbances in children with ADHD compared to their typically developing peers after controlling for moderating variables (age, sex, medication status, body mass index, and psychiatric and medical comorbidities). Methods: ADHD was diagnosed using DSM-IV-TR criteria (Diagnostic and Statistical Manual of Mental Disorders) and Conners' Parent Rating Scales. Children recruited (aged 6−12 years) for the ADHD group (n = 40) met the following criteria: IQ > 80, unmedicated, and no psychiatric or medical comorbidities. The control group consisted of age- and sex-matched typically developing peers (n = 40). Sleep was assessed subjectively (through parent reported questionnaires and sleep logs) and objectively (using video polysomnography). Results: 65% of children with ADHD had a sleep disorder, as compared to 17% of controls. The ADHD group reported more sleep disturbances and disorders, both on subjective measures and objective measures. Conclusions: Sleep disturbances and primary sleep disorders in children with ADHD exist independent of moderating variables and differences in sleep assessment methods, thereby bolstering support for previously documented literature on the ADHD and sleep connection.

Health-related quality of life in Indian patients with three viral sexually transmitted infections: herpes simplex virus-2, genital human papilloma virus and HIV.

BACKGROUND: Health-related quality of life (HRQOL) has not been studied in Indian patients with viral sexually transmitted infections (STIs): herpes simplex virus-2 (HSV-2) and genital human papilloma virus (HPV) infections. Furthermore, there is no reported study that compares HRQOL among these two viral STIs and HIV. METHODS: All consenting adults with any of the three viral infections attending a sexually transmitted disease clinic and 35 healthy controls were enrolled. HRQOL was evaluated using the WHOQOL-BREF instrument, which evaluates QOL under physical, psychological, social and environmental domains. Data concerning demographic and socioeconomic status were collected. RESULTS: There were 65 (27.3%), 60 (25.2%) and 53 (22.3%) patients with HIV, HSV-2 and HPV, respectively, and 25 (10.5%) patients with mixed infections. The WHOQOL-BREF scores of patients in different STI groups were significantly lower than those of controls. The total HRQOL scores (mean±SD) were 280.1±83.56 (among controls), 196.9±72.41 (genital HPV), 141.0±50.50 (HSV-2), 101.0±75.25 (HIV) and 103.4±47.23(mixed infection groups). Mean HRQOL scores were lowest in the physical and psychological domains. HRQOL scores were least in HIV and mixed infections groups, while patients with genital HPV infection had significantly better HRQOL scores compared to other patient groups. Higher education and socioeconomic status had a positive influence on HRQOL. CONCLUSION: Viral STIs were associated with a significant reduction in HRQOL scores. Among patient groups, the greatest impact on HRQOL was seen in those with HIV and mixed infections and the least impact seen in those with genital HPV infection. Comprehensive care including counselling services need to be implemented in STI clinics.

Sex of rearing seems to exert a powerful influence on gender identity in the absence of strong hormonal influence: report of two siblings with PAIS assigned different sex of rearing.

There is an ongoing debate regarding the relative contribution of nurture over nature in development of gender identity. Patients with partial androgen insensitivity syndrome (PAIS) have ambiguous genitalia and are known to be reared as male or female. Familial cases of PAIS sharing common hormonal defects are usually reared in the same sex. Here, we describe two siblings with PAIS, one reared as a male and the other as female. These two siblings presented at adolescence. Gender identity was concordant with the sex of rearing for both. The male sibling was distressed with gynecomastia that had disrupted his social life. The sex of rearing seems to have played a predominant role in the formation of gender identity in these two patients with PAIS.

Psychiatric Co-morbidities and Body Shape Dissatisfaction in Adolescents with Obesity - A School Based Case Controlled Study.

OBJECTIVE: To compare the psychiatric co-morbidity and Body image disturbances of obese adolescents with age and gender matched normal weight controls. METHODS: A case control study was conducted in a school in New Delhi. Nine hundred seventy six students were screened for height and weight and body mass index (BMI) was calculated. Thirty one consenting obese students as per International Obesity Task Force (IOTF) guidelines and 31 age and gender matched normal weight students were recruited for the study. Semi-structured questionnaires were used to assess socio-demographic details, psychiatric co-morbidity using the Mini International Neuropsychiatric Interview- child and adolescent version (MINI-KID), and body image disturbances by Body Shape Questionnaire- the 8 items shorter version (BSQ-8C). The authors examined the relationships between variables measured on these scales and anthropometric data. RESULTS: Of the 976 students screened, 33 (3.38%) students were obese; 21 boys (3.25%) and 12 girls (3.65%). Of the 31 consenting obese subjects and an equal number of age and sex matched controls included in the study, 68% and 7% of them were diagnosed with a DSM-IV disorder based on MINI-KID respectively. The most common diagnosis in the obese group was social phobia (36%) followed by specific phobia (19%) and major depressive disorder (19%). Ninety percent of the obese samples expressed concern over body shape as against 29% in the control subjects. Among obese subjects, 36% expressed mild concern, another 36% expressed moderate concern and 19% expressed marked concern over body shape. CONCLUSIONS: Psychiatric co-morbidity and body shape dissatisfaction are common in obese non-treatment seeking adolescents and warrants need for comprehensive evaluation and management of these issues to manage the epidemic of adolescent obesity in India.

Identification and characterization of two Bordetella avium gene products required for hemagglutination.

Bordetella avium causes bordetellosis in birds, a disease similar to whooping cough caused by Bordetella pertussis in children. B. avium agglutinates guinea pig erythrocytes via an unknown mechanism. Loss of hemagglutination ability results in attenuation. We report the use of transposon mutagenesis to identify two genes required for hemagglutination. The genes (hagA and hagB) were adjacent and divergently oriented and had no orthologs in the genomes of other Bordetella species. Construction of in-frame, unmarked mutations in each gene allowed examination of the role of each in conferring erythrocyte agglutination, explanted tracheal cell adherence, and turkey poult tracheal colonization. In all of the in vitro and in vivo assays, the requirement for the trans-acting products of hagA and hagB (HagA and HagB) was readily shown. Western blotting, using antibodies to purified HagA and HagB, revealed proteins of the predicted sizes of HagA and HagB in an outer membrane-enriched fraction. Antiserum to HagB, but not HagA, blocked B. avium erythrocyte agglutination and explanted turkey tracheal ring binding. Bioinformatic analysis indicated the similarity of HagA and HagB to several two-component secretory apparatuses in which one product facilitates the exposition of the other. HagB has the potential to serve as a useful immunogen to protect turkeys against colonization and subsequent disease.

Pattern & correlates of neurocognitive dysfunction in Asian Indian adults with severe obstructive sleep apnoea.

BACKGROUND & OBJECTIVES: No published data are available on neurocognitive dysfunction in Asian Indians with obstructive sleep apnoea (OSA). We therefore, studied the pattern and correlates of neurocognitive dysfunction in Indian adults with severe OSA. METHODS: Fifty patients aged 25-65 yr with severe OSA (apnoea-hypopnoea index>30) and 25 age, sex, and education level-matched normal controls were studied. Both groups were administered a standardized battery of neurocognitive tests. RESULTS: Patients with severe OSA had significantly impaired performance on tests of alertness, working memory, response inhibition, problem solving, and executive function. However, the difference in executive function between the groups disappeared after adjusting for delayed information processing. The test scores did not correlate with apnoea-hypopnoea index, arousal index, or Epworth sleepiness score. However, the percentage of time spent at <90 per cent oxygen saturation had a weak correlation with the number of stroop errors (Spearman's rho=0.64; P=0.033), number of trials required (rho=0.05; P=0.02), and perseverative errors on Wisconsin card sorting test (rho=0.36; P=0.02). INTERPRETATION & CONCLUSIONS: Our results suggested that delayed information processing rather than impaired abstract thinking was probably the cause of impaired performance on composite tests of neurocognitive function in patients with severe OSA.

Smartteen- a computer assisted cognitive behavior therapy for Indian adolescents with depression- a pilot study.

The prevalence of unipolar depression among adolescents in India is high. Cognitive behavior therapies (CBTs) are considered the current gold standard treatment for depression in adolescents; however, their access is limited in India. Given the ubiquity of technology including smartphones and computers, technology can be leveraged to improve access of CBT treatment in India. Our team developed smartteen- a computer application designed to augment in-person CBT for treatment of depression in adolescents. This paper will present results of the pilot evaluation of smartteen (a cCBT) for its feasibility, acceptability and effectiveness in reducing depressive symptoms. Twenty-one adolescents with unipolar depression seeking treatment at a tertiary care hospital were randomly assigned to smartteen (n = 11) and TAU (n = 10). Both groups received twelve weeks of treatment and were assessed at baseline, mid-treatment (6 weeks) and post-treatment (12 weeks) using four clinical measures including BDI-II, CDRS-R, CGI-S and CGAS. smartteen was shown to be feasible and acceptable treatment to adolescents. At 6 weeks, both treatments were effective in reducing depression. At 12 weeks, smartteen was significantly more effective than TAU in reducing depression symptoms and improving functioning on CGAS. Treatment compliance was better in smartteen group. smartten was shown to reduce the time spent by therapist to deliver 12 sessions of CBT treatment for depression. Results indicate that smartteen may be subjected to more rigorous evaluations with larger samples and considered for wider implementation if found effective.