Absolute Abstinence as a Treatment Outcome in Servicemen with Alcohol Dependence: A Retrospective Cohort Study.

Background: Within India's military medical framework, alcohol dependence syndrome (ADS) is deemed a treatable medical illness incompatible with military service, and complete abstinence is the only acceptable successful treatment outcome. Objective: This study was designed to identify factors which were able to differentiate treatment outcomes of abstinence and relapse among ADS patients in a military framework. Method: Recognizing personal incentives to misrepresent alcohol consumption, abstinence, and relapse outcomes were established using official reports from a patient's parent unit, in combination with biochemical parameters and clinical examination. Patients serially admitted for ADS treatment or follow-up review were surveyed, and their socio-demographic and alcohol consumption profiles, coping styles, life events and specific relapse precipitants were recorded and compared as contributory variables in a cognitive-behavioral model of ADS. From this survey of 140 patients, membership to abstainer or relapser groups was then predicted using a discriminant analysis. Results: 34% of patients achieved early absolute abstinence. No baseline socio-demographic or drinking profile distinctions existed between abstainers and relapsers. Differences were forthcoming on coping styles, life-event, and relapse-precipitant exposure measures. Stepwise discriminant analysis produced a final equation comprising 10 independent variables (including two positive life event measures), which predicted an abstinence/relapse outcome with an 86% and 79% hit-rate (original and cross-validated). Conclusion: Using prevailing cognitive-behavioral constructs, early absolute abstinence emerged as an actionable objective and an achievable goal without any contributory socio-demographic predilections. This preliminary evaluation suggests it is a tenable and realistic target of current ADS treatment programs.

Psychiatric comorbidity in multiple sclerosis.

AIM: To study the prevalence of psychiatric comorbidities in patients of multiple sclerosis and their association to the degree of disability. METHOD: Psychiatric symptoms were assessed in 90 patients of multiple sclerosis using GHQ-12, MMSE, HADS, Beck Depression Inventory and AUDIT. Neurological disability was assessed using Expanded Disability Status Scale. Correlations were determined between EDSS scores and psychiatric scale scores. RESULT: 61% of patients had significant psychological distress. Depression was most common (38.8%) which was followed by anxiety symptoms (27.8%). Cognitive functioning was relatively intact in patients with mild to moderate neurological disability. Alcohol abuse was mostly restricted to male gender. CONCLUSION: Psychiatric illness is highly prevalent in patients of multiple sclerosis leading to poor quality of life and significant distress. Psychiatric disability was higher in patients who had greater deterioration in neurological function. All cases of MS should be assessed for psychiatric morbidities as can be alleviated by appropriate intervention.

Cognitive deficits due to thermal stress: An exploratory study on soldiers in deserts.

BACKGROUND: It is well known that environmental factors play an important role in human performance. High temperature and humidity particularly impair mental performance by altering brain neurochemistry and electrolyte disturbance which in turn affect one's overall efficiency. While the physiological responses to environmental heat have been well established, it is less clear about its impact on cognition. Study aims to investigate the impact of thermal strain on cognition. METHODS: One hundred (100) healthy soldiers aged between 20 and 30 years who had spent minimum of one year in desert conditions prior to their induction in the study formed sample of the study. The subjects were evaluated on memory and on cognitive functions twice i.e. in the month of February and June. The data so generated was analyzed by appropriate statistical methods. RESULTS: The mean age of the subjects were 25.8 yrs. There was a significant decline in cognitive performance in hot climate as compared to normal weather on Post graduate Institute (PGI) memory scale (P < 0.05). The effect was more marked for tests requiring sustained attention, concentration, psychomotor performance, verbal memory and tests of executive function. CONCLUSION: The present study is the first study to be conducted in actual desert conditions. Findings revealed a detrimental impact of thermal stress on the cognitive performance of soldiers in deserts.

Interaction of media, sexual activity and academic achievement in adolescents.

BACKGROUND: Adolescence is a period when the individual is vulnerable and exposure to sexually implicit/explicit programs on television and internet can influence their sexual behaviour and make them more permissive towards premarital sex, which is known to influence their academic performance. This can be modified by parental discussion on these matters with their children. There have been only few studies from India that have explored such issues therefore this study aimed to explore the impact of television, internet and parental discussion on sexual activity and academic performance. METHODS: This study was conducted in two co-education schools using a self reporting questionnaire administered to students of class IX-XII. This study evaluated the relation of academic performance, exposure to media such as television & internet to sexual activity & academic performance of the students and the role of parental discussion on these. RESULTS: The study sample size was 586. There is no significant association between the number of hours of watching television per day and academic performance as measured by marks in examinations. Significant positive association was found among boys between sexual contact and average score in academics & unsupervised use of internet. In both genders a significant positive association was found between those watching English serials, movies and increased chances of indulging in sexual activity while a negative relation with those watching Cartoons. There is no significant difference in occurrence of sexual contact in those who discussed sexual matters with parents and those who did not. CONCLUSION: This being first of it's kind of study from India and a cross sectional study, further prospective and detailed studies are warranted to delineate the interaction of media, parental discussion, academic performance and sexual activity.

Augmenting mental health literacy of troops in a large military station: A novel approach.

Background: Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops. Materials and Methods: 1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months. Results: Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months. Conclusions: Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

A cross-sectional assessment of stress, coping, and burnout in the final-year medical undergraduate students.

BACKGROUND: Medical students undergo significant stress during training which may lead to own suffering or problem in patient care. High level of burnouts and depression is also not uncommon. The transition from preclinical to clinical training has been regarded as crucial to student in relation to the stress. METHODOLOGY: An assessment of perceived stress and its relation to general psychopathology, the pattern of coping, and burnout in the final-year medical student was done to bring out clear nature, pattern, and extent of the problem. RESULTS: Perceived stress had statistically significant association with general psychopathology and depressive-anxiety component of burnout. Acceptance, positive reframing, humor, planning, and active coping correlated with lower score on perceived stress. CONCLUSION: Higher score on perceived stress was associated with higher scores on general psychopathology and burnout. Age of joining MBBS course and doctor in the family did not affect the stress significantly. People who displayed positive coping strategies had lesser stress and general psychopathology.

Studies on the metabolism of beta-carotene and apo-beta-carotenoids in rats and chickens.

(1)The relative abilities of the various fractions of rat and chicken liver to oxidize and reduce retinal and 8'-and 12'-apo-beta-carotenal were investigatjed and it has been shown that, while retinal is exclusely oxidized by the soluble fraction, the apocarotenals are mostly oxidized by the particulate fractions of the homogenate. (2) Addition of NAD+ or NADP+ markedly activated the oxidation of the apocarotenals, but not of retinal by the particulate fractions. (3) Considerable amounts of retinal and 8'-, 10'- and 12'-apo-beta-carotenal were isolated from the intestine of chickens fed beta-carotene and these apocarotenoids were conclusively identified. (4) Significant amounts of 8'-, 10'- and 12'-apo-beta-carotenoic acids were isolated from the intestine of rats given 8'-apo-beta-carotenal and these apocarotenoic acids were also conclusively identified. (5) In the light of these observations it is suggested that during conversion to vitamin A, the beta-carotene molecule is simultaneously attacked by the dioxygenase at several double bonds, the primary attack being at the central double bond and a tentative scheme for the mechanism of conversion is proposed.

Psychiatric Advance Directives in India: What will the future hold?

Psychiatric Advance Directives (PADs) have been incorporated into India's Mental Health Care Bill, 2013. This is the first time any form of Advance Directive stands to receive legal sanction in India. PADs have numerous theoretical and empirically tenable therapeutic and financial advantages. Western experiences have shown high acceptance for the concept among psychiatric patients, and illustrated that most stable patients with severe mental illness retain the capacity to frame PADs consistent with community practice standards. However active psychopathology does impair this capacity, and therein, current subjective assessments of competence performed by Physicians without objective instruments are often inaccurate. Though PADs champion patient autonomy, when applied and studied, they have shown little significant advantage-there is currently not enough data to support evidence-based universal recommendations for PADs. PADs as incorporated into the Mental Health Care Bill model on existing Western statutes, and though many of the strengths of earlier systems have been subsumed, so have several of the shortcomings. The risks, benefits and applicability of PADs in India are complicated by the social re-calibration of patient autonomy, mental-healthcare delivery system weaknesses, and the relatively peripheral role the Psychiatrist is mandated to play in the entire advance directive process. Treating patients within the framework of their pre-stated wishes will be a much more intricate and arduous task than most of modern Psychiatric practice in India, but the difficulties, obstacles and inevitable failures encountered will provide evidence of the delivery system's weaknesses and thereby contribute to its strength.

Crosssectional study of quality of life after renal transplant in end stage renal disease.

BACKGROUND: End stage renal disease (ERD) is a psychologically debilitating illness with considerable emotional morbidity. There is variation in quality of life and mental health status among recipients and donor at different stages of kidney transplantation. MATERIALS AND METHODS: The study is an observational analytic study. Sample for the study comprised of forty (40) consecutive patients including 20 recipients and 20 donors of 20 kidney transplantations, male and female, and who themselves/whose relatives provided written informed consent were included in the study. Both recipients and donors were followed-up from 2 weeks prior to transplant surgery to 6 months post-operatively by phone and when they came for review in Nephrology Out-Patient Department (OPD). Quality of life and mental health status was compared between the two groups. RESULTS: Study groups were homogeneous on age, education, gender and marital status. After transplantation recipient's mean score in all parameters had increased and all changes were statistically significant (<0.05). CONCLUSION: In this study significant changes in quality of life (QOL), and mental health status in recipients and donors before and after transplantation were noted. It is recommended to evaluate mental health related aspects of both donors and recipients.

Central registry in psychiatry: A structured review.

BACKGROUND: Central registry in psychiatry is being practiced in few countries and has been found useful in research and clinical management. Role of central registry has also expanded over the years. MATERIALS AND METHODS: All accessible internet database Medline, Scopus, Embase were accessed from 1990 till date. Available data were systematically reviewed in structured manner and analyzed. RESULTS: Central registry was found useful in epidemiological analysis, association studies, outcome studies, comorbidity studies, forensic issue, effective of medication, qualitative analysis etc.. CONCLUSION: Central registry proves to be effective tool in quantitative and qualitative understanding of psychiatry practice. Findings of studies from central registry can be useful in modifying best practice and evidence based treatment in psychiatry.

Munchausen syndrome: Playing sick or sick player.

Munchausen syndrome is rare factitious disorder which entails frequent hospitalization, pathological lying and intentional production of symptoms for sick role. Management requires collateral history taking, sound clinical approach, exclusion of organicity and addressing psychological issues. A case which presented with unusual symptoms of similar dimension is discussed here. The case brings out finer nuances in evaluation and management of this entity.

Optogenetics in psychiatry: The light ahead.

Complexities of the human mind have been beyond the scope of understanding because a intricate neuronal network and difficulty in specific localization and assessment of area responsible for a specific behavior; more so in a freely moving living being. Optogenetics off late has been able to address this issue to great extent and holds promises for future. Relevant literatures in this direction were looked into and the salient aspects of this science is being discussed here with specific relevance to psychiatry.

A cross-sectional study of factors associated with adolescent sexual activity.

CONTEXT: Adolescents constitute about 20% of our population and increasingly more of them are initiating sexual activity at an early age. Several behaviors associated with adolescence like masturbation, expression of masculinity/femininity, lifestyle habits like attending late night parties, and consumption of alcohol have been variously implicated in initiating sexual activities. Sexual abuse can also lead to premature sexualization. In view of few worthwhile studies from India that have dealt with these issues this study was undertaken. AIMS: To elicit information from two co-education schools adolescent boys and girls on matters related to pubescence, sexual experiences, and sexual health. SETTINGS AND DESIGN: Study subjects involved students from class IX to XII in two co-education schools. Consent of parents was taken to administer the questionnaire to their wards. MATERIALS AND METHODS: A total of 586 out of 1580 students completed a self-reporting questionnaire on matters related to sexuality. Statistical Analysis EpiInfo6 Software was used. RESULTS: Significant association was found among those holding the view that having sex proves their masculinity, being sexually abused, masturbation among boys, and sexual activity. A significantly large number of boys and girls are unaware of role of alcohol on sexual activity and that pregnancy can be caused by single intercourse. CONCLUSIONS: This was probably the first such comparative study from India. Mechanisms need to be evaluated to help adolescents understand their sexual attitudes and situations that are likely to provoke sexual activity. Therefore, not only more detailed and longitudinal studies are needed to understand these relations in a better perspective, but also a well-planned educational program for adolescents is a need of the hour.