Explanatory Models and their Relationship with Drug Attitude in Patients with Depression in South India.

Background: The patient's understanding of the illness may mediate beliefs towards its treatment. There is a paucity of studies examining the relationships between these variables in depression. This study was conducted to know the relationships between explanatory models and attitude to medication in depression. Methods: 494 patients with depression in remission were assessed with sociodemographic proforma, Drug Attitude Inventory, and Mental Distress Explanatory Model Questionnaire. Results: A favorable attitude toward medication was observed in 57.49% of participants. Mean scores on MDEMQ subscales Stress, Western Physiology, Non-Western Physiology, and Supernatural were 32.96, 21.87, 10.06, and 47.55, respectively. Statistically significant associations were found between attitude towards medication and the patient's marital status (more negative attitude with single status, χ2 = 11.72, df = 3, P = 0.008) and occupation (more negative attitude among unemployed patients, χ2 = 4.17, df = 1, P = 0.041). The scores of explanatory models did not differ based on positive or negative drug attitude. Conclusion: Though explanatory models are not linked to patient attitudes toward medication, patients who are single or unemployed have a negative attitude toward medications. Such negative attitude may impair compliance and worsen patient outcomes.

Diagnostic approach and use of CTPA in patients with suspected pulmonary embolism in an emergency department in Saudi Arabia.

Background: In patients with suspected pulmonary embolism (PE), the literature suggests the overuse of computerized tomography pulmonary angiography (CTPA) and underuse of clinical decision rules before imaging request. This study determined the potential for avoidable CTPA using the modified Wells score (mWS) and D-dimer assay in patients with suspected PE. Methods: This hospital-based retrospective study analyzed the clinical data of 661 consecutive patients with suspected PE who underwent CTPA in the emergency department of a tertiary hospital for the use of a clinical prediction rule (mWS) and D-dimer assay. The score was calculated retrospectively from the available data in the files of patients who did not have a documented clinical prediction rule. Overuse (avoidable) CTPA was defined as D-dimer negativity and PE unlikely for this study. Results: Of 661 patients' data examined, clinical prediction rules were documented in 15 (2.3%). In total, 422 patients (63.8%) had required information on modified Wells criteria and D-dimer assays and were included for further analysis. PE on CTPA was present in 22 (5.21%) of PE unlikely (mWS ≤4) and 1 (0.24%) of D-dimer negative patients. Thirty patients (7.11%) met the avoidable CTPA (DD negative+PE unlikely) criteria, and it was significantly associated with dyspnea. The value of sensitivity of avoidable CTPA was 100%, whereas the positive predictive value was 90.3%. Conclusion: Underutilization of clinical prediction rules before prescribing CTPA is common in emergency departments. Therefore, a mandatory policy should be implemented regarding the evaluation of avoidable CTPA imaging to reduce CTPA overuse.

Panic disorder in general medical practice- A narrative review.

The under-or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common among non-psychiatric physicians. The non-psychiatrist physician's role is vital in the care of PD as most patients initially approach general medical settings for medical help, including primary care. However, a significant proportion is undiagnosed and undergoes either unnecessary investigation, misdiagnosed, or mismanaged even among post-Coronary Artery Bypass Grafting patients, which profoundly affects the patients functioning and quality of life. This article aims to provide overviews of relevant epidemiological aspects, presenting features across medical specialties with respective diagnostic dilemmas, assessment, and management of the PD in their general medical settings, including emergency visits. Apart from psychiatrists, this will also assist non-psychiatrist physicians across all medical specialties, including general practitioners, to understand, identify, and provide the first line evidence-based pharmacotherapy and address the unmet need of patients with PD in their day-to-day busy clinical practice. This paper also provides a referral guide for non-psychiatrist physicians to refer to psychiatrists for further management after their first-line management.

Level and Relationships of Life Satisfaction with Cognitive Flexibility and Resilience in IT Professionals.

Introduction: Information Technology (IT) professionals commonly encounter occupation-related issues that adversely affect psychological health and well-being. Aim and Objective: To study the level and relationships of life satisfaction with cognitive flexibility and resilience in IT professionals. Materials and Methods: In this cross-sectional study, 457 IT professionals were assessed with Sociodemographic proforma, Cognitive Flexibility Scale (CFS), Cognitive Resilience Scale (CRS), and Satisfaction with Life Scale (SWLS). Statistical Analysis Used: Descriptive statistics, Student's t-test, ANOVA, and linear regression analysis. Results: The mean score on CRS was high (4.5), whereas on CFS was low (49.36). The mean score on SWLS was also low (17.36) particularly with widowed and disrupted family status, positively linked to the scoring of CFS & CRS, and negatively linked to hours of work. Conclusions: Among Indian IT professionals, cognitive flexibility and life satisfaction are low and influenced by family. Life satisfaction is proportionately linked to cognitive flexibility and resilience.

Level and relationships of academic skills and family functions with academic performance during Covid 19 pandemic.

Background: The research indicates that academic skills and family function may influence academic achievement. The Covid 19 epidemic has impacted regular academic and family function. However, there is a dearth of studies evaluating the relevance of academic skills and family function on college students' academic achievement. This research was done to determine the levels and relationships between academic achievement and study skills and family functions. Two hundred seventy-nine college students were assessed with Sociodemographic and academic proforma, Study Skills Assessment Questionnaire (SSAQ), and The McMaster Family Functioning Scale (MFFS). Results: Results revealed that the mean score of SSAQ and MFFS were 179.92 and 17.88, respectively. Multiple regression analysis showed that the score of reading skills and the MFFS score statistically significantly predicted the score of the exam. Conclusions: On the basis of this study's results, it is possible to conclude that reading skills and family functioning may influence academic success.

Levels and Relationships of Impulsivity and Aggressive Driving in Shaqra, Saudi Arabia.

Background: Aggressive driving is prevalent and may be associated with impulsivity. The relationships between these variables among Saudi drivers have received scant attention. In this study, we aimed to examine the level of aggressive driving and its relationships with impulsivity among Saudi drivers in Shaqra. Methods: Overall, 504 Saudi drivers were recruited and assessed in this cross-sectional study using demographic and driving proforma, a self-reporting Barratt impulsiveness scale (BIS), and an Aggressive Driving Behavior Scale (ADBS). Results: BIS and ADBS had mean scores of 37.97 (3.24) and 21.74 (8.51), respectively. In linear regression analysis, the value of the BIS non-planning subscale negatively predicted the value of the ADBS Conflict subscale (beta = -.151, p = .002) and Speeding subscale (beta = -.103, p = .031). In contrast, the value on the score of the BIS Motor subscale statistically significantly and positively predicted the value on the score of the ADBS Speeding subscale (Beta = -.103, p = .032). Conclusion: The result shows a differential link between the component of impulsivity and aggressive driving. The lack of foresight is negatively linked with conflict behavior and high- speed driving, whereas acting without thinking is positively associated with high-speed driving.

Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study.

Background: Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician's or patient's reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables. Methods: This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV). Results: Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ2 = 7.86, P = 0.04), lower educational qualification (χ2 =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ2 = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ2 = 4.49, P = 0.03). Conclusions: Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.

Suicide among Indian doctors.

BACKGROUND: India has one of the largest numbers of doctors in the world. It is estimated that more than 1 million doctors are in India. Every year more than 80,000 medical students graduate as doctors from 529 medical colleges in India. Medical profession is considered as more stressful, but mental health is still a subject of taboo in medical profession in Indian context. Doctors have higher suicide risk, 2.5 times more than the general population. In the United Kingdom, 430 doctors committed suicide between the years 2011 and 2015. Even though suicide among doctors is reported in Indian media, there is hardly any scientific study that has looked into the suicide among Indian doctors because of many hurdles in the collection of information. MATERIALS AND METHODS: All the Indian newspaper that are published in English and are available in the online platform were scrutinized on doctors suicide report from the year 2016 March to 2019 March. RESULTS: Thirty suicides were reported between 2016 March and 2019 March, out of which 18 were female and 12 male. More than 80% were younger than 40 years. Twenty-two were from medical education institutions. Seventeen were from south India and 13 from North India. Eight were MBBS students and ten were postgraduate students. Among subspecialties, six doctors were from Anesthesia. Seventeen used hanging as a method for suicide, eight used medications, and five jumped from building to end life. Nineteen of suicide reports about doctors mentioned that they were depressed. CONCLUSION: Suicide among Indian doctors is concern. Majority are young undergraduate and postgraduate medical students. Female doctors were more than male doctors. Most doctors were reported to be depressed and used lethal method such as hanging and medications.

Relationship between life skills, repetitive negative thinking, family function, and life satisfaction in attempted suicide.

BACKGROUND: Impaired life skills, family dysfunction, negative thinking and low life satisfaction may predispose to suicidal behavior. There is paucity of study that examined these variables in suicide attempt. AIMS: This study was conducted to know the levels and the relationships of these variables in attempted suicide. SETTINGS AND DESIGN: Hospital-based cross-sectional. MATERIALS AND METHODS: In this hospital-based cross-sectional study, 328 participants with a history of attempted suicide were assessed using socio-demographic and clinical pro forma, life skills profile (LSP), perseverative thinking questionnaire (PTQ), satisfaction with life scale (SLS), and family assessment device (FAD) after obtaining informed consent. STATISTICAL ANALYSIS: Descriptive statistics, Mann-Whitney U and Kruskal-Wallis-H test and regression analysis. RESULTS: Results revealed a mean scores on PTQ, LSP, SLS, and FAD to be 29.93 (standard deviation [SD] =13.5), 21.32 (SD = 13.5), 15.71 (SD = 6.8), and 26.46 (SD = 4.57), respectively. In linear regression analysis (R 2 = 0.815, df = 3, F = 475.715, P = 0.001), LSP score had a statistically significant positive association with PTQ score (beta = 0.861, t = 32.76, P = 0.001) and FAD score (beta = 0.068, t = 2.79, P = 0.0046); while negative association with SLS score (beta = -0.078, t = -2.92, P = 0.004). CONCLUSIONS: The study findings suggest of impaired life skills, life dissatisfaction, impaired family function, and elevated repetitive negative thinking pattern in attempted suicide. Better life skills have a positive association with higher life satisfaction, family function, and low repetitive thinking and thus seem to have a protective effect against suicidal behavior in the population.

Correlation of Cognitive Resilience, Cognitive Flexibility and Impulsivity in Attempted Suicide.

CONTEXT: Impaired cognitive flexibility and resilience and increased impulsivity are presumed to underlie an attempt of suicide. There is, however, a paucity of research examining their relationship in those who attempted suicide. AIMS: To know the correlation of cognitive flexibility and resilience and impulsivity in attempted suicide. MATERIALS AND METHODS: Two hundred seventy subjects with suicide attempt (s) were assessed with sociodemographic and clinical proforma, cognitive flexibility scale (CFS), cognitive resilience scale (CRS), and Barratt impulsiveness scale (BIS-15). STATISTICAL ANALYSIS USED: Descriptive statistics, linear regression model. RESULTS: Mean scores on CFS, CRS, and BIS-15 were 44.93 (SD ± 2.50), 4.49 (SD ± 0.25), and 36.13(SD ± 2.13), respectively. On linear regression analysis, BIS-15 nonplanning had statistically significant negative correlation with CFS and CRS scores, and BIS-15 attention had a positive correlation with CFS and CRS scores. CFS and CRS scores were positively correlated. CONCLUSIONS: In attempted suicide, cognitive flexibility and resilience are interrelated positively and inversely associated with impulsivity (nonplanning and inattention).

Correlation of cognitive functions with emotional dysregulation in alcohol dependence: A preliminary study.

CONTEXT AND AIMS: Dysfunction of cognition and emotion is known in alcohol dependence; however, their relationship in alcohol dependence is unknown. Thus, this study aimed to know the level of emotional dysregulation and cognitive functions and their correlation in patients with alcohol dependence. MATERIALS AND METHODS: In this hospital-based cross-sectional study, 120 patients with alcohol dependence were consecutively recruited and assessed with sociodemographic and clinical pro forma, Montreal Cognitive Assessment (MoCA), and Difficulty in Emotional Regulation Scale-Short Form (DERS-SF). STATISTICAL ANALYSIS: Descriptive statistical, Kruskal-Wallis H, and regression analysis. RESULTS: Results revealed a mild level of cognitive impairment (mean MoCA score = 0 23.76) and high levels of emotional dysregulation (mean DERS-SF score = 0 26.90). On linear regression analysis (R 2 = 0.266, df = 0 1, F = 0 42.782, P =0.000), the score on MoCA had statistically significant negative association with score on DERS-SF (P = 0.001). CONCLUSIONS: Cognitive impairment and emotional dysregulation are inversely related in patients with alcohol dependence. Improving the dysfunction may improve the outcome of alcohol dependence.

Explanatory Models and Medication Adherence in Patients with Depression in South India.

INTRODUCTION: Conceptualization of depression may have bearing on treatment seeking. It may affect adherence behaviour of the patients. AIM: To find out the explanatory models and their relationship with socio-demographic variables and medication adherence in patients with depression. MATERIALS AND METHODS: Fifty-eight consecutive patients with depression in remission were recruited as per selection criteria. Socio-demographic details were collected. Patients were assessed using Mental Distress Explanatory Model Questionnaire (MDEMQ) and Morisky Medication Adherence Scale (MMAS). RESULTS: Significant scores were observed in all dimensions of explanatory models. In the Mann-Whitney U test the patient's marital status (MU=113.500, p=0.05, sig≤0.05, 2-tailed), and family history of mental illness (MU=165.5, p=0.03, sig≤0.05, 2-tailed) had a statistically significant group difference in the score of MDEMQ. In linear regression analysis, four predictors (MDEMQ subscales Stress, Western physiology, Non-Western physiology and Supernatural) had significantly predicted the value of MMAS (R2=0.937, f=153.558, p<0.001). CONCLUSION: Findings of this study suggested that patients with depression harbor multidimensional explanatory model. The levels of explanatory models are inversely associated with levels of medication adherence.

Correlates of Process of Suicide Attempt and Perception of Its Prevention.

Objective: Suicide attempt may follow a process right from the inception of the first information about suicide until the act itself. This study was conducted to determine the relationship between perception of suicide prevention with the process of suicide attempt and demographic variables following a suicidal attempt. Method: In this hospital based cross-sectional study, 168 consecutive admitted participants with a suicide attempt were screened, and 109 who met the study criteria were recruited to participate in this study before discharge. They were assessed using the socio-demographic and clinical proforma designed for this study as well as by the Pierce Suicide Intent Scale. To assess the process of suicide attempt and perception of suicide prevention, a 17- item questionnaire was developed and used after rigorous literature search. The Cronbach's alpha coefficient value of this questionnaire found to be 0.84 in the reliability analysis. Results: Media was the first source of information, and the majority had short duration of preoccupation and interval between making the decision and the actual attempt and the control of emotion during the attempt. A significant positive correlation was observed between the source of the first information and age (p<01), reason for the method used and economic status (p<01), duration since the first information and family history of suicide (p<01). Psychiatric diagnosis had a statistically significant association with the method used (p<01), duration of preoccupation (p<01), preparedness (p<01) and emotional state during the attempt (p<01). A statistically significant negative correlation was found between the source of the first information and education (p<01), any psychiatric diagnosis and duration since the first death wish (p<01). On the score of perception about suicide prevention, a significant group difference was observed for marital status, occupation, medical diagnosis, opinion about an attempt, duration since the decision to attempt, and emotional control during the attempt. Conclusion: Based on the findings, it can be concluded that perception of suicide prevention may vary with the process of suicide attempts and demographic characteristics. .

A Prospective Surveillance of Pharmacovigilance of Psychotropic Medicines in a Developing Country.

AIMS/OBJECTIVES: Psychotropic drugs are associated with significant short-term and long-term safety issues which may affect patients' mental health, physical health and cost of care. EXPERIMENTAL DESIGNS: This was a prospective study conducted in psychiatry department of a tertiary care hospital. Study included patients of any age and either sex who presented with psychiatric illness as diagnosed by ICD-10 and were receiving at least one psychotropic agent. The study involved both intensive and spontaneous reporting methods to identify ADRs. Causality, Severity, Preventability of reported ADR was assessed using standard scales. PRINCIPLE OBSERVATION: Of 4321 patients reviewed, 1630 patients met study criteria, 990 ADRs were identified from 613 patients at an overall incidence rate of 37.6%. Antidepressants were the commonest group of agents implicated in ADRs (42%) followed by Antipsychotics (41%). Escitalopram (15.9%) and Olanzapine (12.1%) were the most commonly implicated medications. Most commonly involved system organ class was Gastrointestinal system (22.7%) followed by Central and peripheral nervous system (17.8%). Dry mouth (10.2%), weight gain (8.18%) and tremors (5.85%) were the commonly reported ADRs. Female gender (p = 0.002), Co-morbid conditions (p = 0.001) and drug- drug interactions (p = 0.000) were found as risk factors in developing ADRs in psychiatry patients. CONCLUSION: Patients receiving psychotropic medicines need routine monitoring to ensure their safety and adherence.

Headache Disability, Suicidality and Pain Catastrophization - Are They Related.

INTRODUCTION: Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache. AIM: To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour. MATERIALS AND METHODS: Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs. RESULTS: In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041). CONCLUSION: Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic class need special attention to reduce high risk suicidal behaviour.

A Case Report of Isotretinoin-induced Manic Psychosis.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.

Study of Barrier to Help Seeking and its Relationships with Disability in Patients with Headache.

INTRODUCTION: Headache is among the first three most prevalent disorders with a wide treatment gap due to barriers in help seeking. Headache has been associated with disability. However, the relationship of barriers to help-seeking and disability are unexplored. AIM: To find out the barriers to help seeking and its relationship with headache related disability in patients with headache. MATERIALS AND METHODS: In this hospital based cross-sectional study, 200 consecutive subjects with headache attending a tertiary care centre were recruited as per selection criteria and assessed with Sociodemographic & Clinical Proforma, Mini International Neuropsychiatric Interview (MINI), Barriers to Help Seeking Scale (BHSS), The Henry Ford Hospital Headache Disability Inventory (HDI). RESULTS: High mean score was observed on BHSS subscale need for control and self reliance (19.45; SD ±9.66) and minimizing problem and resignation (10.02; SD ±6.98). Mean score on the HDI was 25.65 (SD ± 14.09). Socioeconomic status of the patient was statistically significant and positively associated with need for control and self reliance (p=0.035), concrete barriers and distrust of care givers (p=0.039), emotional control (p=0.005), and privacy (p=0.002). Occupational status had significant association with need for control and self-reliance (p=0.01), minimizing problem and resignation (p=0.033), and emotional control (p=0.006). Score on hospital headache disability inventory significantly predicted the value of score on concrete barriers and distrust of caregivers domain of HDI (p=0.001). CONCLUSION: Autonomy and under estimation of seriousness of headache are common barriers to help seeking. Pattern of help seeking barriers may vary with socio-economic status and occupational status, while disability varies with gender and severity of headache. Headache associated disability is positively associated with concrete barriers.

Assessment of impact of pharmacophilia and pharmacophobia on medication adherence in patients with psychiatric disorders: A cross-sectional study.

AIMS: To investigate the impact of pharmacophilia and pharmacophobia on medication adherence among patients with psychiatric disorders. MATERIALS AND METHODS: A cross-sectional, observational study was conducted in the Department of Psychiatry over a period of 2 months. Patients above 18 years of age with a psychiatric diagnosis as per the International Classification of Diseases 10 and receiving at least one psychotropic medication (any medication capable of affecting the mind, emotions, and behavior) for >1 month were enrolled in the study. Patients who were critically ill, on magico-religious treatment (beliefs prevalent in a particular culture concerning various supernatural influences operating in the environment), diagnosis of dementia, or mental retardation and patients from whom reliable history of illness cannot be obtained were excluded from the study. Drug attitude inventory scale was used to classify patients into pharmacophilic and pharmacophobic groups. Medication adherence rating scale was used to identify the extent of medication adherence. RESULTS: Among 176 patients included, 110 were found to be pharmacophilic and 54 were pharmacophobic. The number of hospitalizations (P < 0.03) and adverse drug reactions (P < 0.001) were found to be higher in pharmacophobic group as compared to pharmacophilic group. Antipsychotics were found to be most commonly prescribed medications among pharmacophobic group (P < 0.001). In this study, patients who had pharmacophilia were found to be have higher adherence score (mean score: 6.98) than patients with pharmacophobia (mean score: 2.9), with P< 0.001. CONCLUSIONS: This study concluded that pharmacophobia toward psychopharmacological agents can significantly reduce the medication adherence among patients with psychiatric disorders.

Multimodal Hallucination (Audio-visual, Kinaesthetic and Scenic) Associated with the Use of Zolpidem.

We are reporting a case of zolpidem induced multimodal hallucinations in a 22 year old female without any history of psychiatric disorders. Zolpidem, by acting on gamma-amino butyric acid type A receptor has a potential to cause a paradoxical reaction and there also exists a possibility of an induced delirium with its use. This case reports evaluates its potential to cause multimodal hallucinations. Zolpidem needs to be prescribed judiciously with the caution of potential side effects particularly in females.