Diagnostic And Statistical Manual Research Articles

The Preventive Role of Perceived Social Support in Postpartum Psychiatric Morbidity: Insights from a Rural Tertiary Care Teaching Hospital in South India

Abstract Introduction: Postpartum psychiatric disorders show a rising trend in developing countries, where the lack of social support is a major risk factor. Evidence from Western scientific literature also reports of similar preventive role of social support in postpartum psychiatric states. However, the attitudes toward childbearing may differ across cultures and also within the same cultural sphere. With this background, we aimed to assess the perceived social support and its association with postpartum psychiatric morbidity in a rural setting in South India. Methodology: A total of 100 postpartum women who met the inclusion and exclusion criteria were included in the study following their consent. Sociodemographic data sheet and Edinburgh Postnatal Depression Scale, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM IV-TR), and Multidimensional Scale of Perceived Social Support were administered on them. Appropriate statistical analysis was done. P <0.05 was considered statistically significant. Results: The majority of our sample recorded high perceived social support (76%), with 90% reporting high support from a special person. 10% had major depressive disorder, out of which 6% recorded melancholia, and 7% recorded suicidality on DSM IV-TR. Increasing age had lower perceived social support, P = 0.024. As perceived social support was reduced, increased psychiatric morbidity was significantly noted, with suicidality and melancholia. Conclusions: Our study finds a significant association between perceived social support and postpartum depression (PPD). Lesser social support was associated with increased suicidality and melancholia features in cases of PPD. Amplification of social support in expectant mothers is a useful way to safeguard against postpartum psychiatric disorders.

Reliability and Validity of Hindi Version of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) for Diagnosis of Delirium: A Cohort Study.

The confusion assessment method for the intensive care unit (CAM-ICU) is a bedside tool to diagnose delirium in critically ill patients. This study aims to determine the reliability and validity of the Hindi version of CAM-ICU against the Diagnostic and Statistical Manual (DSM), fourth edition text revision (DSM-IV-TR), and DSM, fifth edition (DSM-5) criteria for diagnosis of delirium. Seventy-five Hindi-speaking consenting patients ≥18-year-old with Richmond Agitation Sedation Scale ≥-3 and an anticipated ICU stay > 48 hours were included. Patients with known severe mental illnesses, visual/hearing loss, neurological injury, burns, drug overdose, and Glasgow Coma Scale <9 at the time of screening were excluded. After 48 hours of ICU stay and ensuring at least 2 hours of sedative interruption, within a 4-hour period, two examiners independently assessed delirium using the Hindi version of the scale and an experienced psychiatrist assessed the patients independently and applied the DSM-IV-TR and DSM-5 criteria for diagnosing delirium. Time taken for CAM-ICU assessment, inter-observer reliability, sensitivity, specificity, and positive and negative predictive values were calculated. The Cohen's κ value was 0.944 (p < 0.001). The Cronbach's α for observer 1 and observer 2 was 0.961 and 0.968, respectively. The sensitivity and negative predictive value of the tool was 100% with both DSM-IV-TR and DSM-5. The specificity was 90.2% and 92% and the positive predictive value was 82.8 and 86.2% with DSM-IV-TR and DSM-5, respectively. The Hindi version of CAM-ICU is a reliable and valid tool for the diagnosis of delirium in an ICU setting. The study was registered with the Clinical Trials Registry, India (CTRI) as per the research guidelines laid down by the Indian Council of Medical Research before enrolling the participants. (CTRI number- CTRI/2021/01/030471). The registration date was 14th January 2021. URL of registry is http://ctri.nic.in. Delirium in the ICU is often undiagnosed due to unfamiliarity, lack of understanding of symptoms, non-availability of psychiatric consultation, and validated diagnostic tools in the native language of the patient. This study aims to find the reliability and validity of the Hindi version of CAM-ICU. Salhotra R, Bose A, Srivastava S, Mohta M, Pandarinathan K, Rautela RS. Reliability and Validity of Hindi Version of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) for Diagnosis of Delirium: A Cohort Study. Indian J Crit Care Med 2024;28(10):958-962.

A clinical protocol for the diagnosis of delirium after stroke in the post-acute setting: The “post-acute stroke delirium assessment” study

Post-stroke delirium (PSD) is an important complication to identify in the inpatient rehabilitation setting due to its negative impact on rehabilitation outcomes. Delirium diagnosis is challenging and is rendered more so in the presence of post-stroke language and cognitive impairments. As delirium is a clinical diagnosis, the majority of PSD studies use a Diagnostic and Statistical Manual (DSM)–based “expert clinical diagnosis” as the reference standard. However, a diagnostic protocol is rarely defined, which undermines transparency, interrater reliability, and reproducibility in delirium research. This report describes the clinical diagnostic protocol for the “Post-Acute Stroke Delirium Assessment” study, a quality improvement initiative to be conducted in adult stroke rehabilitation inpatients at a tertiary academic hospital. The main study goals are to explore how delirium features present in this patient group and to use this information to create a new screening tool specific for PSD in inpatient rehabilitation. This protocol evaluates 16 delirium features, including those encompassed by the DSM, fifth edition, text revision as well as other features absent from the DSM, and delineates how to determine whether each feature is “present, absent, or unable to assess.” This protocol may also be valuable in informing delirium diagnosis in other patient groups with or without neurological deficits.

Longitudinal association of exposure to work-related stress with major depressive disorder and the role of occupational burnout in this association in the general population.

To prospectively assess (1) the associations of Effort-Reward Imbalance (ERI), its individual components, and over-commitment with (a) the onset of a Major Depressive Episode (MDE) during a 3.6-year follow-up in a population-based cohort in participants with no current Major Depressive Disorder (MDD) in the beginning of the follow-up (n = 959), (b) incidence of MDD in the subsample of participants exempt from lifetime MDD (n = 490), and (c) the onset of a new MDE (i.e. recurrence) in the subsample of participants with remitted but no current MDD (n = 485), and (2) potential effect modification of burnout on these associations. DSM-IV Axis-I disorders were elicited using thesemi-structured Diagnostic Instrument for Genetic Studies at each investigation. The ERI Questionnaire was used to measure ERI and overcommitment. Burnout was measured with the Maslach Burnout Inventory General Survey. Serially adjusted logistic regression models were used. The effect of burnout dimensions on these associations was assessed by testing interactions between the ERI and burnout dimensions. (1) ERI was prospectively associated with the onset of MDE, even after adjustment for burnout [OR (95CI) = 1.22 (1.003-1.49)]. (2) The association between ERI and MDD incidence became non-significant after adjusting for burnout. (3) ERI was not associated with recurrence of pre-existing MDD. (4) burnout did not interact with ERI. Our results support a longitudinal association between ERI and the risk of onset of MDE in the community. Burnout did not modify this effect, but it may partially account for the association between ERI and MDD incidence.

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorder Interview Schedule- Autism Spectrum Addendum (ADIS-ASA) in Autistic Youth.

Examine the concurrent validity of specific Anxiety Disorders Section of the Anxiety Disorder Interview Schedule for DSM-IV-Autism Spectrum Addendum (ADIS-ASA)-Parent Interview in a sample of 167 autistic youth who met diagnostic criteria for an anxiety-related disorder (Mage = 9.91; 78.4% male; 82% non-Hispanic; 77.67% White). Concurrent validity of Diagnostic and Statistical Manual (DSM)-defined ADIS-ASA anxiety disorder diagnostic caseness was examined via relations with (a) parent-reported dimensions of youth anxiety symptomology and (b) dimensional measures of youth anxiety-related functional impairment, respectively, using logistic regression models and point-biserial correlations. Significant relations were found between separation anxiety disorder and social anxiety disorder (but not generalized anxiety disorder nor obsessive-compulsive disorder) caseness, respectively, and theoretically consistent facets of dimensional youth anxiety symptomology. Relations between ADIS-ASA diagnostic caseness and youth functional impairment-related variables revealed that only separation anxiety disorder demonstrated robust evidence of convergent validity. Despite mixed findings concerning relations between ADIS-ASA anxiety disorder diagnostic caseness and dimensional measures of anxiety severity and anxiety-related impairment, the present findings provide further support for the status of the ADIS-ASA as a gold standard for assessment of anxiety in autistic youth. This work also highlights the importance of continuing to improve precision in measurement of anxiety symptomology in autistic youth, with implications for clinical assessment.

The Grief Debate, the DSM, and Clinical Practice.

There has been an ongoing debate regarding grief, whether it may be at times pathological, and whether it is different from depression. This article addresses those questions by tracking the changing course of the Diagnostic and Statistical Manuals of Mental Disorders (DSMs) since DSM-III and by reviewing the debate concerning grief and depression. At the time when DSM-III was being prepared in the late 1970s (it was published in 1980), there was a concern that normal bereavement (or grief) was being diagnosed as major depression. To address this concern, the editors of DSM-III added a category of "uncomplicated bereavement." The fourth edition of the DSM (DSM-IV), published in 1994, then followed by a minor change. However, the editors of DSM-5 decided to eliminate the bereavement exclusion entirely. Their concern was simply whether the individual did or did not suffer from major depression. Since an individual might not warrant a diagnosis of major depression but might still be experiencing grief, the DSM discussion leads directly into the question of whether grief-later called prolonged grief disorder-and depression are separate conditions. Advocates for prolonged grief disorder maintained that grief is different from depression but that patients may present with a mix of grief and depressive symptoms that are clinically difficult to distinguish. Advocates of separate conditions have in fact developed an inventory of symptoms that identify prolonged grief disorder. However, inasmuch as a typical grief presentation will include depressive symptoms, the clinical challenge is to distinguish prolonged grief disorder and major depression, as well as to distinguish both from normal grief. Given the temporal limits of an average consultation, this article argues that making the required distinctions is an unrealistic expectation. Finally, researchers have developed specific treatment programs for prolonged grief disorder, but a conflict between the 2 primary researchers involved and the generalities in which the programs are phrased have led to the suggestion of a different approach to treatment that replaces generalities with a person-centered approach.

Comparison of Monocyte to Lymphocyte and Platelet to Lymphocyte Ratio between Patients with Depression according to Severity of Disease

Background: Depression is one of the most common psychiatric disorders with global public health concern that is linked to systemic inflammation. The monocyte to lymphocyte (MLR) and platelet to lymphocyte ratio (PLR) are partially new markers which may be evaluated with simple blood test and which are shown to be highly informative in showing chronic low grade inflammation associated with pathophysiology of depressive disorder. Objective: To evaluate the relation of MLR and PLR between patients with depression according to severity of disease. Methods: This observational study was conducted in the Department of Psychiatry of Jahurul Islam Medical College Hospital (JIMCH), Bajitpur, Kishoregonj between November 2012 and April 2013. Subjects between the age group of 25 and 55 were included in the study that involved 253 subjects with diagnosed depressive disorder according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Revised Text (DSM IV-TR) who received no pharmacological therapy of depression within the past 01 month. A sociodemographic information form and the Hamilton Rating Scale for depression (HAM-D) were administered. Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Blood sample were taken for biochemical analysis and complete blood parameters were evaluated in the hematology laboratory of JIMCH. All data were expressed as mean±SD. For statistical analysis, Chi-square test (χ2) was used to compare categorical variables, frequencies, and ratios. An independent sample ‘t’ test was used to compare normally distributed variables between two groups. Results: In the present study, it was found significant differences in the MLR, PLR, monocyte, leukocyte values of the patient group with depression according to severity of disease. Severe and very severe depression had significantly higher MLR levels compared to patients with mild and moderate depression. On the other hand, mild and moderate depression. On the other hand, mild and moderate depression had significantly higher PLR levels compared to patients with severe and very severe depression. Conclusion: In summary, the findings of the study reveal that higher HAM-D scores are associated with higher MLR and lower PLR levels in patients with depressive illness compared to patients with lower HAM-D scores. Moreover, a high MLR values supports the view that inflammation is a critical factor in the etiology of depression. JAFMC Bangladesh, Vol 19, No 2 (December) 2023:12-15.

Stress Exposure and PTSD in a Cross-Sectional Residential Substance Use Treatment Sample.

Aim 1 of this cross-sectional, observational study with people in residential treatment for substance use disorders (SUDs) was to document stress exposure. Aim 2 was to assess potential sociodemographic and health differences based on probable posttraumatic stress disorder (PTSD) status. Aim 3 was to assess relative contributions of Diagnostic and Statistical Manual (DSM)-congruent versus DSM-incongruent stressors (Criterion A vs non-Criterion A) to mental and physical health. We hypothesized that both types of stressors would significantly contribute to impairment across indicators and that DSM-congruent stressor exposure would be more strongly associated with impairment than DSM-incongruent exposure. We assessed exposure to DSM-congruent traumatic stressors and DSM-incongruent life stressors, PTSD and depressive symptoms, emotion regulation difficulties, substance use recovery capital, and physical/mental health-related quality of life among 136 people in residential SUD treatment who were 64% men, 36% women; 49% white, 41% Black, 11% multiracial/another race; 18% lesbian, gay, or bisexual (LGB+); mean age = 39.82 (standard deviation = 12.24) years. Participants reported experiencing a mean of 9.76 (SD = 6.11) DSM-congruent events. Those with probable PTSD were younger and more likely to be LGB+ than those without probable PTSD (P < .05). Experiencing higher numbers of DSM-congruent events was associated with more severe PTSD and depressive symptoms, emotion regulation difficulties, and lower physical health-related quality of life (P < .05). DSM-incongruent stressor exposure was not independently associated with any indicators. Recovery capital was not associated with either type of stress exposure. Stressful event exposure among people in residential SUD treatment is very high. Those who are younger or LGB+ in residential SUD treatment may be at greater risk of developing PTSD. DSM-congruent stressors are more consistently associated with mental health indicators than are DSM-incongruent stressors. Prioritizing treatment targets and identifying implementable treatment strategies can be challenging with this complex population.

Prenatal &amp; Perinatal Risk Factors of Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is lifelong neurodevelopmental disorder characterized by impairments in social function, communication, and certain behaviors. The etiology of ASD is unclear &amp; it is believed to be multi-factorial, among those several prenatal &amp; perinatal factors are found to be significant. So, the necessity of this study is to detect the presence of known risk factors of ASD which in turn may help in the early diagnosis and intervention for better long-term outcomes. Objective: To find out prenatal and perinatal risk factors of ASD. Method: A case control study was conducted with 112 cases of ASD and 201 controls of 2-6 years of age. The study was carried out in Center for Neurodevelopment and Autism in Children (CNAC), in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University and Autism Welfare Foundation (AWF). ASD was diagnosed by DSM-IV TR criteria. Mothers were interviewed and data were collected by semistructured questionnaires. Results: Total 5 risk factors were identified as the risk factors of ASD. They were: advanced paternal age (OR=2.84) and maternal age (OR=1.87); male baby (OR=2.01); environmental stress during pregnancy (OR=1.61) and preterm delivery (OR=1.80). Conclusions: It is concluded that advanced paternal age, maternal age, male baby, environmental stress during pregnancy and preterm delivery are associated with increased risk of ASD. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 115-121

Common mental disorders among adolescents in an urban area of Delhi.

Common mental disorders (CMDs) among adolescents may hamper their psycho-social development. This study evaluated the prevalence and determinants of CMD like depression and anxiety among late adolescents of an age of 15--19 years residing in an urban resettlement colony of southeast Delhi. A community-based cross-sectional study was carried out among 556 randomly selected adolescents. CMD was assessed using Mini International Neuropsychiatry Interview - Kid version 6 (MINI-Kid) based on DSM-IV TR and compliant with ICD-10 definitions of CMD. The associated risk factors were studied using a self-developed semi-structured interview schedule and analyzed using multi-variable logistic regression. A total of 491 adolescents were interviewed (a response rate of 88.3%), of whom 247 (50.3%) were female and 210 (42.8%) belonged to a lower-middle socio-economic status. The lifetime prevalence of CMD was 34% [95% confidence interval (CI): 29.8-38.2]. Of the total, 22.4% (95% CI: 18.7-6.1) of the participants reported depression and 6.7% (95% CI: 4.5-8.9) reported generalized anxiety disorder during their lifetime. Female sex [adjusted odds ratio (aOR) 2.1, 95% CI: 1.4-2.2], experiencing a stressful event in the past 6 months (aOR 4.7, 95% CI: 3.1-7.3), and smoking tobacco (aOR 2.0, 95% CI: 1.2-7.4) significantly increased the odds of having CMD in multi-variate analysis. There is a high prevalence of CMD among adolescents residing in urban resettlement colonies of Delhi, which is composed mostly of people belonging to lower socio-economic strata. Hence, tailored intervention at stress management with promotion of healthy lifestyle is needed for this age group.

Prevalence and concordance of International Classification of Diseases-11th Revision and Diagnostic and Statistical Manual-Fifth Edition posttraumatic stress diagnostics among Northern Irish military veterans.

There are two primary competing diagnostic criteria for posttraumatic stress disorder (PTSD); the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). These systems differ in terms of the number and nature of PTSD symptoms, the implied latent structure of the disorder, and associated posttraumatic diagnostic classifications. To investigate the prevalence and concordance of ICD-11th Revision (ICD-11) and DSM-Fifth Edition (DSM-5) PTSD, complex-PTSD (C-PTSD), and dissociative subtype of PTSD (D-PTSD) criteria in a sample of Northern Irish military veterans. Data were collected from a community sample of military veterans living in Northern Ireland (NI). Prevalence rates of ICD-11 PTSD and C-PTSD and DSM-5 PTSD and D-PTSD were estimated using validated self-report measures for each system. Concordance of caseness determined by diagnostic criteria was compared using Cohen's kappa. The DSM-5 algorithm criteria produced significantly higher prevalence estimates of PTSD (39.26%) relative to the ICD-11 algorithm criteria (32.09%). Both C-PTSD and D-PTSD were identified for subgroups within the sample (24.66% and 27.96%, respectively). There was moderate agreement between the diagnostic systems regarding PTSD caseness, and between C-PTSD and D-PTSD caseness. These findings have implications regarding the measurement of PTSD and associated diagnostic groupings for the wider literature, suggesting that the choice of diagnostic screening framework may influence classification. Both C-PTSD and D-PTSD may be relevant diagnostic considerations for the NI military veteran group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between posttraumatic stress disorder and race-based traumatic stress.

This study examined the relationships between race-based traumatic stress symptoms (RBTSS), posttraumatic stress disorder (PTSD) symptoms, and negative affect (NA) in the past year. Participants were 185 community-based respondents who completed a paper and pencil survey of the race-based traumatic stress symptoms scale (RBTSSS), diagnostic and statistical manual (DSM)-related PTSD symptoms, and negative emotions. Two canonical correlation analyses were conducted for two participant groups: those with no race-based traumatic stress (RBTS) elevations and those with one or more RBTS elevations. Results showed a significant relationship between RBTS symptoms and PTSD symptoms for the no elevation group, and a significant relationship between RBTS symptoms and NA for the race-based stress/traumatic stress group. Notably, RBTS inclusion was not significantly correlated with NA. Those with average-level RBTS symptoms appear to endorse more PTSD criteria, while those with elevated RBTS scores do not. The study, therefore, highlights the need for further investigation of how diagnostic measures of trauma may differentiate from trauma symptoms related to race-based experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Behavioral and emotional functioning of children with specific learning disorders

Background: Specific learning disorder (SLD) is distinct from other Diagnostic and Statistical Manual (DSM)-5 mental disorders as it is recognized clinically in medicine and as a separate category in special education. Aims and Objectives: The study aimed to study the behavioral patterns and emotional functioning in children with SLD. Materials and Methods: This observational cross-sectional study was conducted at Tirunelveli Medical College, Tirunelveli, from January 2019 to April 2020 on 100 patients (study group 50 and control group 50) diagnosed with SLDs as per DSM5 criteria. A patient’s history includes age, gender, symptoms, and diagnosis. Assessments were done through a semi-structured proforma, Rutter Children’s Behavior Questionnaire (parent form), the Vanderbilt attention deficit hyperactivity disorder (ADHD) diagnostic rating scale, and the Rosenberg self-esteem scale (RSES). Results: The patient’s domicile in rural areas was 82% compared to urban areas, which is 18%. The Rutter scale – total score was higher in the study group, with a mean of 3.24, compared to the control group, with a mean of 0.44. The RSES compared self-esteem scores and the mean self-esteem scores of 21.56 and 14.72, respectively (P&lt;0.0001). The deviant/antisocial behavior subscale scores were higher for the study group, with a mean score of 1.08, than the control group, with a mean score of 0.02 (&lt;0.05). The ADHD (inattentive type) Vanderbilt scale was compared, and it was found to be positive for the study group and none for the control group (P=0.022). Conclusion: The scores show a significant correlation between higher rates of neurotic behavior and behavioral problems, predominantly inattentive types, in SLD children.

Psychosexual dysfunction in male patients with cannabis dependence and synthetic cannabinoid dependence.

There are contradicting reports regarding the relationship between cannabis use and male sexual functions with almost no data about synthetic cannabinoids (SC) and its effect on male sexual functions. This study investigates psychological concerns related to male sexual functions among cannabis and SC users. The research aims to assess different sexual functions and aspects of sexual psychopathology in cannabis and SCs dependent men compared to controls. Thirty male patients with cannabis dependence, thirty male patients with SCs dependence and thirty matched controls from the outpatient clinic of Kasr Al Ainy hospital, Egypt, were assessed using Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID-I), International Index of Erectile Function (IIEF), and Sexuality scale. The means of IIEF questionnaire in the cannabis and SC group were significant lower than the means of the control group (P < .001) except the orgasmic function in cannabis group (P = .052). In the SCs group, sexual depression was higher and preoccupation lower than the cannabis (P < .020; P < .003, respectively) and control groups (P < .001; P < .001, respectively). The duration and dose of intake of cannabis and SCs correlated significant with sexual esteem, sexual preoccupation and all domains of IIEF. Cannabis and SC dependence were associated with lower erectile function, sexual desire, intercourse satisfaction and overall satisfaction, and lower orgasmic functions in the SC group than controls. Both groups showed higher sexual depression, lower sexual esteem and sexual preoccupation than controls. SC has a higher negative impact on male sexual functions and psychopathology than cannabis.

Diagnosing Human Trafficking Victims: A Mini-Review and Perspective

The global campaign against human trafficking, also known as trafficking in persons, has gained much momentum in the past two decades. Although psychiatric and physical illness sequela of human trafficking are well documented, the research community continues to struggle over such foundational questions as what specific activities or experiences count as trafficking-in-persons victimization and how best to obtain representable and generalizable data on experiences of people who are trafficked. We provide a brief review of major efforts to define trafficking in persons to establish prevalence estimates to date. We argue for consensus on key clinical and public health indicators, resembling the Diagnostic and Statistical Manual (DSM) approach to enable common and systematic knowledge building and comparability across studies.

Development and validation of a prognostic index for mental health and substance use disorder burden

ObjectiveTo develop an accessible index which quantifies MHSUD burden among patients of Veterans Affairs hospitals. MethodWe used 21 disorder categories provided by the diagnostic and statistical manual (DSM) to characterize diagnoses among primary care (PC) patients. For each patient, we generated counts of unique disorder categories present during the PC encounter or in the year prior. We used these counts to generate multiple indexes, which we compared in a 60% training sample of our population. Using model fit statistics generated from ordered multinomial logistic regressions, we identified the subset of DSM categories which, structured as index, were most predictive of MHSUD hospitalization and death. We validated and fine-tuned the form of the selected index in the full population using measures of calibration and discrimination. ResultsIn model development, the index (I-6) which best fit the data (R2 = 0.191) included the following six disorder categories: substance use, depressive, psychotic, bipolar, trauma, and personality. When applied in the full population and weighted by disorder severity, this index demonstrated good predictive discrimination for MHSUD death (C = 0.66) and hospitalization (C = 0.88) and was well calibrated in comparisons of observed versus predicted outcomes. ConclusionsWe recommend the I-6 as a parsimonious and effective tool for MHSUD burden risk adjustment.

Depression in young women after hysterectomy: Emergency obstetric versus elective procedure – A comparative cross-sectional study

Emergency obstetric hysterectomy (EOH) is done during cesarean section or after normal vaginal delivery, or any time during puerperal period. Puerperal period is usually associated with anxiety and depression in most cases, having emergency hysterectomy can potentially trigger it more. Therefore, this study was conducted to compare emergency versus elective hysterectomy to determine the pattern of depression between two groups. During a period of four years (from 1st march 2019 to 28th February 2023), a total of 6658 patients were admitted in obstetrics &amp; gynecology department and 31 underwent emergency obstetric hysterectomies and consented to be part of this study. These females were aged between 18 to 49 years. For comparison 31 married control females were randomly selected and interviewed 3 months after undergoing elective hysterectomy due to gynecological conditions. There was no past family history for any psychiatric illness in both groups. The studied groups were clinically evaluated for major depressive episode according to the American Psychiatric Association diagnostic and statistical Manual of mental disorders, 4th edition text revised (DSM-IV TR) criteria. Beck depression inventory (BDI)18 to assess the severity of major depressive episodes. Out of 31 patients 16 cases were performed after caesarean section, four during laparotomy for ruptured uterus and 11 for uterine atony after normal vaginal delivery. There was significantly higher rate of depression among patients undergoing emergency hysterectomy as compared to those with elective procedure. The frequency of complications was also observed to be higher in emergency cases. Our study concluded that the frequency of complications and severe depression was remarkably higher in the obstetric emergency hysterectomy group as compared to the elective hysterectomy group.

Using the Research Domain Criteria as a framework to integrate psychophysiological findings into stress management and psychotherapy interventions.

Research on the psychophysiology of stress is expanding rapidly, but the field lacks a clear integrative framework to help translate research findings into empirically supported stress interventions. The Research Domain Criteria (RDoC) is an excellent candidate to explore as a framework to integrate stress research. The RDoC framework is a dimensional, multi-modal approach to psychopathology proposed as an alternative to categorical approaches used by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). The goal of this paper is to explore the RDoC as a framework to integrate psychophysiology research into therapeutic interventions for stress. The RDoC consists of six domains: negative valence systems, positive valence systems, cognitive systems, social processes systems, arousal/regulatory systems, and sensorimotor systems, and provides an excellent structure for integrating information from multiple levels of functioning including physiology, behavior, and self-report, as well as genes, molecules, cells, and brain circuits. Integrating psychophysiological research on stress using the RDoC framework can direct and amplify stress management and psychotherapeutic interventions. First, the RDoC provides a clear foundation for conceptualizing the stress response in terms of important concepts such as allostasis and adaptation. In this perspective, the terms "allostatic response" or "adaptation response" are more descriptive terms than "stress response" in understanding bodily responses to life threats and challenges. Second, psychophysiological approaches can be used in the context of modalities such as biofeedback and mindfulness to both collect psychophysiological data and then integrate that data into a broader therapeutic framework. Heart rate variability (HRV) biofeedback is being used more frequently as part of a therapeutic intervention package with stress management and psychotherapy, and HRV data is also used to provide outcome evidence on the efficacy of treatment. Mindfulness practices are commonly used in combination with stress management and psychotherapy, and psychophysiological data (HRV, EEG, blood pressure, etc.) is often collected to explore and understand mind/body relationships. In conclusion, the lack of a clear framework to assess and understand mind/body functioning limits current stress research and interventions. The RDoC provides a strong framework to assess and integrate physiological and psychological data and improve stress interventions.

What clinical analysis of antipsychotic-induced catatonia and neuroleptic malignant syndrome tells us about the links between these two syndromes: A systematic review

ObjectivesAntipsychotic-induced catatonia (AIC) and neuroleptic malignant syndrome (NMS) are life-threatening adverse reactions to antipsychotic medication. We conducted a systematic review of literature following the PRISMA statement guidelines to obtain a description of these syndromes (population, context of occurrence, antipsychotic agents implicated) and draw conclusions about their links. MethodsWe searched Medline and Web of science databases from January 1951 to May 2019 (further restricted from 2000 to 2019) using search terms including “catatonia”, “neuroleptic malignant syndrome” and “antipsychotic agents” for case reports, case series and analytic studies. After screening 4082 records, 410 full-text articles (describing 555 events) were assessed for eligibility. We included events of AIC and/or NMS according to Diagnostic and Statistical Manual (DSM) criteria and extracted data about patients' characteristics, context of occurrence, antipsychotic agent(s) involved and treatment outcomes. ResultsWe included 165 events (16 AIC, 129 NMS and 20 AIC + NMS) from 144 case reports and case series. The most reported diagnosis was schizophrenia. Comorbid pre-existing conditions such as central nervous system diseases and acute medical events were common. Most of the events (63.3 %) occurred during antipsychotic monotherapy. Second-generation antipsychotics (SGAs, 63.8 %) were overall more implicated than first-generation antipsychotics (FGAs, 36.2 %). DiscussionOur findings highlight that any antipsychotic medication, even SGA monotherapy prescribed at recommended dose, is at risk for these side effects. FGAs and polypharmacy seem to represent risk factors for malignant catatonia in AIC. The clinical overlap observed between AIC and NMS events in our review suggests a clinical continuum between catatonia and NMS.

Prevalence of mixed features in patients with first-episode depression: An exploratory multicentric study.

There is limited literature on the prevalence of mixed features in patients with depression, especially from countries in Asia. Our aim was to evaluate the prevalence of "mixed features" in patients with first-episode depression. Patients with first-episode depression were evaluated for the presence of mixed features as per the Diagnostic and Statistical Manual (DSM)-5 criteria. They were additionally evaluated on Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). About one-sixth (16%) of the patients fulfilled the DSM-5 criteria for the mixed features specifier. The most common manic/hypomanic clinical feature was increased talkativeness or pressure of speech, followed by elevated expansive mood (12.5%), and inflated self-esteem or grandiosity was the least common feature (8.7%). Those with mixed features had higher prevalence of comorbid tobacco dependence and psychotic symptoms. In terms of frequency of depressive symptoms as assessed on HDRS, compared to those without mixed features, those with mixed features had higher frequency of symptoms such as depressed mood, insomnia during early hours of morning, work and activities, agitation, gastrointestinal somatic symptoms, genital symptoms, hypochondriasis, and poorer insight. Mixed features specifier criteria were fulfilled by 16% patients with first-episode depression. This finding suggests that the extension of this specifier to depression can be considered as a useful step in understanding the symptom profile of patients with depression.