Impact of the COVID-19 pandemic on psychosocial health and well-being in South-Asian (World Psychiatric Association zone 16) countries: A systematic and advocacy review from the Indian Psychiatric Society.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. The South-Asian (SA) countries have witnessed both the initial brunt of the outbreak as well as the ongoing rise of cases. Their unique challenges in relation to mental health during the pandemic are worth exploring. MATERIALS AND METHODS: A systematic review was conducted for all the original studies on the impact of COVID-19 and lockdown on psychological health/well-being in the SA countries of the World Psychiatric Association Zone 16. PubMed, Google Scholar, PSYCHINFO, EMBASE, and SCOPUS were searched till June 2020. Studies conducted in the age group of 18-60 years with a minimum sample size of 10, and statistically significant results were included. RESULTS: Thirteen studies were included in the review. They showed increase prevalence in nonpsychotic depression, preanxiety, somatic concerns, alcohol-related disorders, and insomnia in the general population. Psychological symptoms correlated more with physical complaints of fatigue and pain in older adults and were directly related to social media use, misinformation, xenophobia, and social distancing. Frontline workers reported guilt, stigma, anxiety, and poor sleep quality, which were related to the lack of availability of adequate personal protective equipment, increased workload, and discrimination. One study validated the Coronavirus anxiety scale in the Indian population while another explored gaming as a double-edged sword during the lockdown in adolescents. Another study from Bangladesh explored psychosexual health during lockdown. Most studies were cross-sectional online surveys, used screening tools and had limited accessibility. CONCLUSION: The ongoing COVID-19 crisis and its impact serve as an important period for adequate mental healthcare, promotion, research, and holistic biopsychosocial management of psychiatric disorders, especially in vulnerable groups. Mental healthcare and research strategies during the pandemic and preparedness for postpandemic aftermath are advocated subsequently.

Psychological Well-being of Medical Students.

BACKGROUND: Training in medicine is emotionally demanding. Psychological well being of medical students is a matter of concern. There is lack of Indian studies in this area. METHODS: A total of 105 medical student of one batch were assessed utilizing psychophysiological state inventory, Institute for personality and ability testing (IPAT) anxiety and depression scale, achievement motivation scale, scale for locus of control and 16 PF in three phases at one-year intervals. RESULT: Majority of the students had average achievement, motivation and adaptability. Anxiety and depression scores fell within normal limits. In personality profile factor 'B', 'M' and 'Q41' had changed significantly. Achievement motivation showed significant decreases and CSS1 and PO1 scores showed significant increase during the years of medical education. CONCLUSION: The results demonstrate that over satisfaction and relaxed attitude may have poor academic outcome.

KLEINE - LEVIN SYNDROME (A Case Report).

A 30 year old male soldier suffered from five episodes of hypersomnia. Each episode was associated with megaphagia, mental confusion, irritability, coenesthopathic hallucinations and sexual disinhibition. The average duration of each episode was ten weeks with symptomfree intervals ranging from two weeks to one year. The patient responded well to treatment with carbamazepine and fenfluramine.

PERSONALITY FACTOR CORRELATES OF GROWTH HORMONE AND HYPOTHERMIC RESPONSE TO BUSPIRONE CHALLENGE IN SUICIDAL SOLDIERS.

The biological underpinnings of suicidal behaviour and possible rational pharmacotherapy of persons exhibiting such behaviour is the focus of this study. The study was conducted on 25 male Armed Forces personnel who attempted suicide and 25 matched healthy controls. Hypothermic and Growth Hormone response to Buspirone challenge was measured serially. 11 cases of attempted suicide had subsensitive postsynaptic 5 HT-1A receptors as indicated by blunted Growth Hormone response, while in other suicidal soldiers hypothermic response was markedly blunted indicating subsensitive presynaptic 5HT-IA receptors in the latter. Personality factor assessment carried out by 16 personality factor test, indicated overt extraversion marks for subsensitive postsynaptic 5 HT-IA receptors, while overt intraversion marks for subsensitive presynaptic 5 HT-IA receptors, in suicidal soldiers. In the light of the above, therapeutic options of Serotonin reuptake inhibition, agonist load at presynaptic 5 HT-IA and reciprocal stimulation of postsynatpic 5 HT-IA receptors for prevention of future attempts and completed suicides is discussed.

DO PERSONALITY FACTORS DETERMINE THE CHOICE OF PROFESSION? AN EXPLORATIVE STUDY OF FEMALE NURSING AND FEMALE MEDICAL STUDENTS.

Medical profession and nursing profession are noble professions. Both professions place heavy emphasis on desirable personality traits of being affectionate, humble and responsible. Personal qualities such as integrity, responsibility and empathy have often been mentioned in the literature as desirable qualities for these professions. The present study was planned to explore these personal attributes. Sample for the study consisted of 26 female medical students of first year MBBS and 29 female nursing students of first year B.Sc. Nursing course. The subjects were matched for age and sex. Personality profile was evaluated by administering 16 Personality Factor Form A. Findings revealed significant differences on factor 'A', 'F', 'H' and 'M'. On second order factors significant differences were noted on introversion-extroversion and independence-subduedness dimension.

TRENDS AND ISSUES IN RELATION TO ALCOHOL DEPENDENCE IN THE ARMED FORCES.

Alcohol dependence syndrome has an estimated prevalence of 1533% of all psychiatric hospitalizations in a year. There is an increasing trend in incidence among JCOs/ORs. The index of admission was highest in Armoured Corps, Mechanized Infantry and Army Medical Corps (AMC). Generally a service personnel becomes dependent at 35 years of age after about 11 years of drinking. The average consumption of alcohol dependent individuals was 6-7 pegs/day. A family history of alcohol abuse/dependence was found in 31 % cases. Alcoholics had high anxiety, depression, extroversion, neuroticism and psychopathic deviate traits. Alcoholism was associated with significantly low self esteem. Significantly more alcoholics were alexithymic as compared to non-alcoholics. The γ glutamyl transferase (GGT) and mean corpuscular volume (MCV) were found to be useful diagnostic aids for alcoholism. Almost a third of alcoholics have potentially serious physical problems, 20% suffer from various degrees of psychotic phenomena, 40-55% have significant marital, occupational and disciplinary problems, while 3-6.93% attempted deliberate self-harm. Despite wide variations in mode of disposal, after diagnosis only a small percentage of alcoholics remain in service beyond three years. There is need for concerted investigations into the precipitating and perpetuating factors, co-morbidity, the process of change towards betterment and the long-term outcome of alcoholism in service personnel.

Effect of short-term Psychiatric Intervention in Cancer Patients.

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.

Effect of Short-term Psychiatric Intervention in Amputees.

A total of 40 patients with limb amputations were included in the present study aimed at evaluating the psychological status of amputees. All patients filled a specially designed proforma and the following psychological questionnaires: General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, Michigan Alcoholism Screening Test and Disability Assessment Questionnaire. Analysis of the results showed that 29 (72.5%) of the amputees had psychiatric disorders and this number had reduced to 20 (50%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating scale for Depression. The amputees had the highest score on vocational subscale of Dysfunction Analysis Questionnaire. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in amputees.

Reduced cerebrospinal fluid and plasma nerve growth factor in drug-naïve psychotic patients.

Impaired expression and function of several major neurotrophic factors such as nerve growth factor (NGF) has been proposed to contribute to the neurodevelopmental pathology of schizophrenia. However, the evidence in the majority of studies is based on variable and inconsistent levels of plasma NGF in diverse populations of early psychosis or medicated patients with chronic schizophrenia. We report here the first study comparing NGF levels in cerebrospinal fluid (CSF) and plasma from a unique patient cohort (unmedicated, early psychotic patients with similar racial and dietary patterns) and matched healthy controls. Significantly lower levels of NGF in both CSF (p=0.038) and plasma (p=0.002) were observed in drug-naïve first-episode psychosis patients as compared to controls. The levels of NGF in the CSF correlated (p=0.05) to the plasma values in controls. The data on plasma NGF confirm the reported deficits of NGF in drug-naïve first-episode psychosis. The reduced levels first time observed here may have important implications to repeatedly reported neurobiological and clinical deficits which are discussed.