International Classification Of Diseases-10 Criteria Research Articles

Correlative analysis of dissociative disorder among Kashmiri population

Correlative analysis of dissociative disorder among Kashmiri population

Patterns and prevalence of psychiatric morbidity among individuals with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects the joints, causing inflammation, pain, and potential joint damage. Patients with RA are at high risk of developing psychiatric morbidity; it is important to recognize these psychiatric manifestations. The relationship between psychiatric symptoms and RA is complex and can involve various factors, including the impact of chronic pain, inflammation, medications, and the overall burden of managing a chronic illness.Aim of the study was to systematically investigate and analyze the patterns and prevalence of psychiatric morbidity among individuals diagnosed with RA, with the aim of identifying common mental health conditions, understanding the interplay between RA and psychiatric disorders, and providing valuable insights for improved holistic patient care. This was a prospective, observational cross-sectional study conducted over a period of three years in patients with RA. Psychiatric morbidity was assessed using International Classification of Diseases-10 criteria and Mini-Plus by dedicated psychiatrists. The diagnosis of RA was confirmed using the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) diagnostic criteria for RA and the disease activity was calculated by Disease Activity Score with 28-joint count (DAS28) using the calculator from the RheumaHelper application. The data were analyzed using SPSS, version 23.0. A total of 1,000 patients with RA were included in this study. Nearly two-thirds of the patients were female (64.8%). The majority of patients belonged to the age group of 41 to 54 years. Total 47.5% of the patients were unemployed, 27.0% were salaried, 19.0% were businessman, while 6.5% of the patients were students. More than half of the patients (53.2%) had moderate disease activity. Major depressive disorder was the most commonly observed comorbidity (41.0%), followed by somatoform disorder (28.5%), and generalized anxiety disorder was found in 13.5%. No psychiatric manifestations were found in 17% of studied individuals. Psychiatric morbidity is associated with RA and there is a need for psychiatric services to be made available to these patients.

Role of Expressed Emotions and Its Impact on Relapse in Bipolar Affective Disorder

Abstract Background: The role of expressed emotions (EEs) in relapse is poorly understood in bipolar affective disorder (BPAD). Understanding the association between EE and relapse will be useful in predicting further relapse and improving the prognosis. Aims and Objectives: The present study was conducted with the objectives of assessing the relationship between EEs of caregivers and relapse of the illness in patients with BPAD on regular medication and to assess the relationship between severity of illness and EEs. Materials and Methods: Fifty consecutive bipolar disorder patients diagnosed as per the International Classification of Diseases-10 criteria, who were admitted into the department of psychiatry with relapse while on regular medication, and their caregivers were recruited into the study. Data were collected using a semi-structured pro forma designed for the study. Clinical details of illness were obtained from the informant and the records. The severity of the current episode was assessed with the rating scales (Young Mania Rating Scale and Hamilton Depression Rating Scale). The Expressed emotions(EE) among the caregivers were assessed using the Family Attitude Scale, association between EE and relapses as well as the severity of illness was analyzed with appropriate tests. Results: The mean age of the patients was 43.8 ± 15.4. Majority of them were male and married (68% and 68%). The mean age of the caregivers was 47.1 ± 10.5. The majority of the caregivers were female (60%). Sixty-four percent of the caregivers had high EEs. The mean age of onset of illness was 26.2 ± 4.6, and the number of previous episodes was 3.9 ± 2.5. The total duration of illness was 17.7 ± 13.4 years, and the number of previous admissions was 3.3 ± 2.2. Among clinical variables of patients and caregivers with high EEs, a significant association was found between duration of illness (Chi-square test: 11.82, P = 0.003), previous episodes (Chi-square test: 12.26, P < 0.01), and the number of previous admissions (Chi-square test: 9.79, P = 0.002). Conclusion: There was a significant association between high EE and relapse.

Incidence of Postpartum Depression and Associated Risk Factors in Antenatal Women: A Cohort Study

Abstract Background: The incidence of postpartum depression (PPD) varies across cultures, regions, and communities, and there are very few studies addressing this issue, henceforth making it difficult to estimate the actual burden of the disease. Aims: The aim of this study was to evaluate the incidence and identify potential risk factors for PPD in a cohort of antenatal women. Methods: This study conducted in a tertiary hospital included 105 participants in their second or third trimester of pregnancy. Relationship with and support from the family were assessed. The scales applied were the Perceived Stress Scale, Ardell Wellness Stress Scale, State-Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index. Participants were followed up 4 weeks postnatally. They were asked about the gender of their baby, and the Edinburgh Postnatal Depression Scale (EPDS) was applied. PPD was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and International Classification of Diseases-10 criteria. Results: Of the 105 participants, 6 were lost to follow-up. Among the 99 women, an EPDS score of ≥10 was identified in 17 women who were diagnosed with PPD. The risk factors according to our study were sleep disturbances, state anxiety, stress, and obstetrical complications antenatally and female sex of the newborn. These risk factors are likely to be interactive as well as multiplicative in effect. Conclusion: The study shows a high prevalence of PPD in Indian mothers. There is enough evidence suggesting that intervention for PPD is crucial for the care of the mother as well as for the well-being of the infant, hence an integrated approach is required for its screening.

Comparison of time domain indices of heart rate variability between alcohol-dependent individuals and non-alcoholic subjects

Background: Alcohol dependence develops because of repeated alcohol intake. Alcohol damages the cardiac autonomic nerve fibers leading to autonomic imbalance, resulting in reduced heart rate variability (HRV). HRV refers to the complex beat-to-beat variation in the heart rate, produced by the interplay of sympathetic and parasympathetic neural activity at the Sino-atrial node. Our body works effectively in parasympathetic activity dominance. The time domain indices of HRV are specific markers of parasympathetic activity. A decrease in the time domain parameters indicates reduced parasympathetic activity in the heart, indicating cardiac autonomic dysfunction with vagal neuropathy. Aims and Objectives: The objectives of the study are as follows: (1) To assess the HRV in alcohol-dependent individuals using time domain indices. (2) To compare the HRV between alcoholic-dependent individuals and non-alcoholic subjects. Materials and Methods: A total of 110 individuals in the age group of 20–55 years were recruited for our study. Among them, 55 were alcohol-dependent individuals selected based on the diagnostic and statistical manual-IV, international classification of diseases-10 criteria, and 55 age and gender-matched volunteers were selected as healthy non-alcoholic controls. Short-term HRV was recorded in a supine posture, and the results were interpreted. Statistical analysis was done using the software SPSS version 21.0. Results: Our results showed a significant reduction in the time-domain parameters of HRV – SDNN, RMSSD, NN50, and pNN50 in the alcohol-dependent individuals compared to the controls, suggesting reduced parasympathetic activity in the heart indicating cardiac autonomic neuropathy. Conclusion: Alcohol affects the cardiac autonomic status leading to sudden death due to arrhythmias. HRV can be used as a non-invasive test to assess cardiac autonomic dysfunction and its biofeedback can help alcohol-dependent individuals to adopt healthy lifestyle measures.

A Study of Clinical Profile and Stressors in Patients Presenting with Dissociative Disorder to a Tertiary Care Teaching Hospital

Background: Dissociative disorder is a condition characterized by disruption of the normal continuity and integration of consciousness, memory, identity, motor functioning, and behavior. Aims: The aim of the study was to study the various psychosocial factors that influence the dissociative episodes in patients. We also looked at the clinical profile and the relation between the type and levels of dissociation with levels of stress in the study sample. Materials and Methods: This descriptive, cross-sectional study with serial sampling had 50 participants who were diagnosed with dissociation as per the International Classification of Diseases-10 criteria. The study was conducted after obtaining clearance from the institutional ethics committee. Dissociative experience of the patients was measured using Severity of Dissociative Symptoms-Adult (Brief Dissociative Experiences Scale [DES-B]-Modified) and stress levels were measured using Presumptive Stressful Life Events Scale. Results: The study showed that dissociation was more common among females from urban population, who were single and among students. Dissociative convulsions were found to be the most common type of dissociation in our culture. DES-B showed moderate-to-severe types of dissociative experience in the sample. In 46% of the participants, family conflicts acted as the most common stressor precipitating episodes. There was a psychodynamic connection/explanation between the perceived stress and the presenting complaint. Conclusion: This study highlights the common dissociations, stressors, and the difference seen among males and females. There is a need to understand the stressors of a patient presenting with dissociation for better psychological management.

A Study to Assess Burden on Caregivers of Opioid Use Disorder

Abstract Background: Substance use disorder is global problem associated with significant socio-occupational dysfunction. It has been increasingly realized that it should be conceptualized as affecting a family and not just an individual. This study aimed at assessing the caregivers’ burden in opioid dependence in a Tertiary Care Teaching Hospital in Punjab. Materials and Methods: This was a cross-sectional study where the sample comprised 50 patients diagnosed with opioid dependence, as per the International Classification of Diseases-10 criteria and their 50 caregivers. The caregivers’ burden was assessed with the help of the Montgomery Borgatta Caregiving Burden Scale, which is a subject-rated scale. Results: Most of the patients (54%) as well as the caregivers (30%) were 21–30 years of age, with male predominance and belonged to rural area, were unmarried, living in a nuclear family, and had a middle socioeconomic status. Most of the patients (88%) reported consuming “Heroin” and 64% reported using two or more than two substances. The mean age of first use of opioid was found out to be 21.8 years, the mean duration of the illness was 8.04 years, and the mean number of relapses was 2.94. About 58% of caregivers had moderate objective burden, 98% had severe subjective burden, and 78% had severe subjective demand burden. Conclusions: There is an urgent need to target the community awareness programs at the adolescent age group and a need to focus on the family rather than the individual patient, in the backdrop of the findings of this study.

Disability assessment in the persons with schizophrenia: Inter-rater agreement and correlation between self-, proxy-, and interviewer-rated versions of the World Health Organization Disability Assessment Schedule 2.0

Abstract Background: Schizophrenia has been described as the most disabling mental disorder, and patients with schizophrenia have been said to be disabled mostly in occupation, sexual relation, self-care, and social relationship domains. Aim: The present study aimed at assessing disability through self-, proxy-, and interviewer-rated versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 among persons with schizophrenia. Materials and Methods: The study was cross-sectional. Thirty samples of patients with schizophrenia as per the International Classification of Diseases-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included in the study. The study was conducted at the Outpatient Department of Mental Health Institute and Department of Psychiatry, Government Medical College and Hospital Sector 32, Chandigarh, India. Results: The overall inter-rater reliability in schizophrenia was 0.599 (0.395–0.767), indicative of moderate reliability. Domains, namely, getting along with people (0.803) and life activities of household (0.854) had a good reliability, whereas domains such as cognition (0.681), mobility (0.616), self-care (0.636), life activities at school/work (0.664), and participation in the society (0.753) indicated a moderate reliability. Conclusion: There was no significant difference among the self, proxy, and interviewer assessments for most items. This study highlighted the fact that service users can also carry out an objective self-assessment of disability, thus upholding the principles of advanced directives as envisaged under the Mental Health Care Act, 2017.

Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients.

BACKGROUNDIn a previous study, basilar artery occlusion (BAO) was shown to lead to death or disability in 80% of the patients. The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy, but not all patients benefit from these treatments. Thus, understanding the predictors of outcome before initiating these treatments is of special interest.AIMTo determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population. METHODSWe performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019. We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke. A neurologist reviewed every case, and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included. We then analyzed the patients’ characteristics and factors related to the 90-d outcome. RESULTSWe identified a total of 99 patients as real BAO cases. Of these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0–3). Moreover, 72 patients received intra-arterial thrombectomy, while 13 patients received intravenous tissue-type plasminogen activator treatment. We observed a favorable outcome in 33.3% of the cases and an unfavorable outcome in 66.7% of the cases. We found that the initial National Institutes of Health Stroke Scale (NIHSS) score and several BAO symptoms, including impaired consciousness, tetraparesis, and pupillary abnormalities, were significantly associated with an unfavorable outcome (P < 0.05), while cerebellar symptoms were associated with a favorable outcome (P < 0.05). In the receiver operating characteristic (ROC) analysis, the areas under the ROC curve of initial NIHSS score, impaired consciousness, tetraparesis, cerebellar symptoms, and pupillary abnormalities were 0.836, 0.644, 0.727, 0.614, and 0.614, respectively. Initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.CONCLUSIONThe most important predictor of an unfavorable outcome was the initial NIHSS score. BAO symptoms, including tetraparesis, impaired consciousness, and pupillary abnormality were also related to an unfavorable outcome.

The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment

PurposeTO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight.DesignProspective cross-sectional comparative study.MethodsSetting: institutional. Patients: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma. Procedure: telephone questionnaires. Main outcome measures: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure.ResultsSurveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age (P = .008) and lower education level (P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P = .045), were concerned about access to health care (P <.001), obtained news through word of mouth (P <.001), and less commonly wore masks (P = .003). Controls more commonly performed frequent handwashing (P = .001), were aware of telemedicine (P = .029), and had fewer concerns about social interactions (P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began.ConclusionsThe pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.

Prevalence of medical comorbidity in early onset versus late-onset depression in Vindhya region.

Background:Late-onset depression differs significantly from early-onset depression according to clinical features, physical comorbidities, cognitive impairment, and cerebrovascular abnormalities, which suggest that these might have differing etiopathological pathways toward the depressive phenotype.Aim:The aim of the study was to identify comorbid physical disorders with late-onset depression.Methods:The present cross-sectional study was conducted in inpatients of the Department of Psychiatry during a period of 18 months. A study consisted of 60 patients of first depressive episode diagnosed using International Classification of Diseases-10 criteria, segregated 2 different groups of Early onset depression (between 40 and 65 years) and late-onset depression (LOD) (>65 years) with 30 patients each.Results:In LOD group, predominant comorbidities were hypertension 56.6%, cerebrovascular disease 36.6%, diabetes 33.3%, cardiovascular disease 23.3%, and anaemia 23.3%, followed by respiratory illnesses, arthritis, benign prostatic hyperplasia and cirrhosis. While, in early-onset depression group, common comorbidities were hypertension (13.3%), anemia (10%), arthritis (10%), and diabetes (6.6%).Conclusions:Hypertension cerebrovascular disease, diabetes, and cardiovascular disease were the predominant comorbidities in late-onset as well as early onset depression.

Effect of Motivational Enhancement Therapy (MET) on the self efficacy of Individuals of Alcohol dependence.

Introduction:Motivational enhancement therapy is characterized as a directive, client-centered intervention which helps in modification of behavior by helping subjects in identifying and resolving the ambivalence toward a change in self. In order to free one from the vicious cycle of the alcohol trap one needs self-efficacy, which serves a protective role to prevent from relapses. The study aims to assess and compare the effectiveness of MET on the self-efficacy of individuals pre and posttest with control design were applied.Methods:A total of 40 subjects, alcohol-dependent persons fulfilling International classification of Diseases-10 criteria were selected through purposive sampling method from Outdoor and Indoor Service of Psychiatry Department IMS BHU, Varanasi, were randomly divided into two groups. 1st group 20 subjects were given motivational enhancement therapy session for 10 sessions along with treatment as usual (MET + TAU), whereas 2nd group control group were given treatment as usual (TAU) at the end of intervention post level of self-efficacy were measured through self-efficacy scale. Modified Kuppuswamy Socioeconomic Status Scale, Alcohol use disorder identification test, Self-Efficacy Scale as tools were used.Result:The result shows that the mean value of self-efficacy in (MET + TAU) group before intervention was 56.30 ± 2.99 and mean value of self-efficacy in (MET + TAU) after intervention was 60.75 ± 2.65 which shows significant difference is found in self-efficacy after intervention.Conclusion:Motivational enhancement therapy tries to decrease ambivalence so as to enhance the change in the subject's self-efficacy which assists the individuals in abstinence from alcohol.

A study of cerebrovascular risk factors in depressive patients in old age

Context: Depression in late life is more likely to be associated with multiple medical comorbidities and cognitive impairment. In old-age hypertension, hyperlipidemia and obesity have been associated with cognitive impairment and vascular depression. The severity of vascular burden has a positive correlation with the severity of depression. Aims: This study aimed to find the association between cerebrovascular risk factors (CVRFs) and depression in old age. Methodology: A cross-sectional observational study was carried out at the outpatient department (OPD) of psychiatric center, SMS Medical College and Hospital, Jaipur. The patients from the OPD who provided informed consent were the participants in this study. Two hundred cases of depressive episode or recurrent depressive episode (unipolar depression) were included in the study. The diagnosis was made as per the International Classification of Diseases-10 criteria by two psychiatrists independently. Framingham CVRF prediction tool was applied to assess vascular burden. This was followed by statistical analysis. Results: The mean age of participants were 68.53 years, the mean score of Hamilton Depression Rating Scale (HAM-D) was 19.10 and the mean score of CVRFs was 13.13. HAM-D score positively correlates with CVRFs score (r = 0.188 and P = 0.008). Conclusions: Our study contributes to the growing literature elucidating the relationship of CVRFs in depressed older adults confirming that greater vascular burden can contribute to the severity of depression in geriatric depression.

Sinhala translation of the Perinatal Anxiety Screening Scale: a valid and reliable tool to detect anxiety disorders among antenatal women

BackgroundAnxiety disorders during pregnancy are not routinely assessed in Sri Lanka despite being common and being associated with adverse pregnancy outcomes. Screening can facilitate early detection and management of anxiety and improve pregnancy outcomes. Our aim was to determine the validity of the Sinhala translation of the Perinatal Anxiety Screening Scale (PASS) to detect anxiety among Sri Lankan pregnant women.MethodsA cross-sectional study was conducted in antenatal clinics of a teaching hospital in Colombo District. The PASS was translated to Sinhala using the standard translation/ back-translation method. Pregnant women (n = 221) were sequentially recruited and assessed by a psychiatrist until 81 women with anxiety disorder were diagnosed using the International Classification of Diseases-10 criteria (gold standard). The Sinhala translation of the PASS (PASS-S) was administered to all recruited women, including 140 women without anxiety. Receiver-Operating- Characteristic (ROC) analysis was performed, the optimal cut-off score for PASS-S was determined, and its validity was assessed using sensitivity, specificity, predictive values and positive and negative likelihood ratios. Internal consistency was assessed using Cronbach’s alpha. Test-retest and inter-rater reliability for PASS-S score and anxiety classification were assessed using intra class correlation coefficient (ICC) and Cohen’s kappa (k), respectively.ResultsThe mean age (±SD) of women was 30(±5.8) years, and 53.7% were multiparous. A psychiatrist diagnosed anxiety disorder was made in 37.0% of women, while the PASS-S, at its optimal cut-off of ≥20, classified 37.5% of women as having anxiety disorders. The area under the ROC curve for the PASS-S was 0.96 (95%CI 0.94–0.99). Sensitivity, specificity and positive and negative predictive values of the PASS-S were 0.93 (95% CI 0.84–0.97), 0.90 (95% CI 0.83–0.94), 0.85 (95% CI 0.75–0.90) and 0.95 (95% CI 0.89–0.98), respectively. Positive and negative likelihood ratios were 8.8 (95% CI 5.3–14.5) and 0.08 (95%CI 0.04–0.18), respectively, and the internal consistency was high (Cronbach’s alpha 0.95). Four-factor structures obtained by exploratory factor analysis were “acute anxiety and adjustment”, “social anxiety, specific fears and trauma”, “perfectionism and control” and “general anxiety”.Test-retest reliability was high for the PASS-S score (ICC 0.85[95% CI 0.65–0.96]) and anxiety classification (k 0.77[95% CI 0.34–1.2]). Inter-interviewer reliability was also high (ICC 0.92[95% CI 0.81–0.97] for the PASS-S score and (k0.86 [95% CI 0.59–1.1] for anxiety classification).ConclusionThe Sinhala translation of the PASS is a valid and reliable instrument to screen for anxiety disorders among antenatal women in Sri Lanka.

Increased serum levels of complement C1q in major depressive disorder

BackgroundThe complement system is involved in multiple biological processes including inflammation, synaptic pruning, and apoptosis. However, it is not well understood whether peripheral complement C1q levels are altered in major depressive disorder (MDD) patients. ObjectiveThis study aimed at assessing serum levels of complement C1q in MDD patients using a cross-sectional, case-control design. Also, the correlations between complement C1q and inflammation and lipid profile in patients with MDD were also assessed. MethodsSerum complement C1q levels were measured by ADVIA 2400 biochemical analyzer in 160 patients with MDD diagnosed using International Classification of Diseases-10 criteria (ICD-10) and were compared with those of 159 healthy controls between January 2017 to May 2019. Then correlation analysis was carried out between the level of serum complement C1q among MDD patients with inflammation and lipid profile. ResultsSerum complement C1q levels were higher in MDD patients than in controls (P < .0001) and the difference between the two groups was small (r = 0.239 [0.128 to 0.350]). We found that serum complement C1q concentrations was positively correlated with HAMD-24 score (r = 0.234, P = .003) and log hs-CRP (r = 0.334, P < .001). ConclusionWe found serum complement C1q levels were significantly higher in MDD patients than in controls. The current results suggest that the dysfunction of complement C1q may be involved in the pathophysiology of MDD.

A comparative study of emotional intelligence in offenders with antisocial personality disorder and normal population at a tertiary care centre in Hyderabad, Telangana

Background: Emotional intelligence refers to ability to monitor own and other people’s emotions. Lack of emotional intelligence can lead to many disturbances in one’s life. A comparison of emotional intelligence in offenders with antisocial personality disorder and in normal population has been done in this study. Aim: The aim is to study emotional intelligence in offenders with antisocial personality disorder and compare it with normal population at a tertiary care centre in Hyderabad. Methodology: It is a cross-sectional and comparative study done at Institute of mental health, Hyderabad. Study sample includes 70 males, out of this 35 were offenders diagnosed with antisocial personality disorder and remaining 35 were from normal population. Tools used in this study are semi-structured intake pro-forma for sociodemographic details and criminal history, Goldberg’s 12 item General health questionnaire, Mangal emotional intelligence inventory, International classification of diseases-10 criteria. Results: The offenders group with antisocial personality disorder scored less on emotional intelligence test domains such as intrapersonal awareness, interpersonal awareness, intrapersonal management, interpersonal management and the total emotional intelligence score when compared to normal individuals and the difference between the two groups was found to be statistically significant. (p = 0.000). Conclusion: The offenders with antisocial personality had significantly lower Emotional intelligence in comparison to the normal group and an inverse relation was observed between levels of emotional intelligence and number of crimes committed. Keywords: Emotional intelligence, Antisocial personality disorder, Criminal offenses.

Effect of probiotic supplementation on cognitive function in children and adolescents: a systematic review of randomised trials.

Available reviews have shown potential effects of probiotics on neurobehavioral outcomes through 'gut-brain axis' mechanism in adults. However, reviews on cognitive function in children and adolescents are lacking. Therefore, we conducted a systematic review of randomised controlled trials (RCTs) of the effect of probiotic supplementation on cognitive function in children and adolescents. A search of four databases (Cochrane Central Register of Controlled Trials, PsycARTICLES, Scopus, PubMed) was conducted to identify RCTs published from January 1990 to December 2018. Seven studies met the inclusion criteria and their cognitive outcomes were analysed. Only one study found a positive result with Lactobacillus rhamnosus GG (LGG) 1×1010 cfu supplementation with outcomes on attention deficit hyperactivity disorder (ADHD) or Asperger syndrome (AS) manifestations as diagnosed using the International Classification of Diseases-10 criteria. The supplementations were administered to Finnish mothers for 4 weeks before delivery and continuously given for 6 months after delivery if they breastfed, or to the children. ADHD or AS was diagnosed at the age of 13 years in 17.1% children in the placebo and none in the probiotic group (P=0.008). This study found significant differences in species composition and number of cells belonging to the genus Bifidobacterium between healthy children and children who later developed ADHD or AS at different time points. Six remaining studies with varying strains, durations of intervention, start-time of administration, and outcomes demonstrated no difference in cognition after probiotic supplementation. Metagenomic analyses on gut microbiota composition were not performed in any of these studies. In conclusion, the favourable effect of probiotic supplementation on cognitive function in children and adolescents was observed in one study with LGG supplementation by a risk reduction of developing ADHD or AS (i.e. autism). More long-term and follow-up trials using probiotics identifying the effect on cognition are warranted before routine use.

Perceived parental style, cognitive style, and resilience in females with dissociative disorder in India.

Background:Dissociative disorders are theorized to be caused by extremely stressful situations, including abuse, kidnapping, incest, rape, and other threats of death. Such childhood experiences alter one's cognitive style as well as one's ability to deal with adverse situations. It is important to understand how cognitive style influences the relationship between parental style and resilience to help in the management. We aimed to assess the relationship between perceived parental styles and resilience mediated by cognitive styles in females with dissociative disorder.Materials and Methods:Sample comprised 60 females between 18 and 50 years of age with dissociative disorder (International Classification of Diseases-10 criteria) in a cross-sectional observational study. Perceived parental style of the participant was assessed using s-EMBU, cognitive style using the Cognitive Style Inventory, and resilience using the Conner and Davidson's Resiliency Scale. Data were analyzed using Shapiro–Wilk to assess the normality of the data and Spearman rank correlation for determining the relationship between the variables.Results:The results indicated a significant relationship between emotional warmth and systematic-cognitive style (rs= 0.398, P = 0.01) and between systematic-cognitive style and high resilience (rs= 0.256, P = 0.05). A significant regression equation was found (F[1, 58] = 9.146, P < 0.004), with an R2= 0.136 to predict systematic-cognitive style based on emotional warmth as the perceived parental style. To predict resilience based on systematic-cognitive style, a significant regression equation was found (F[1, 58] = 6.006, P < 0.017), with an R2= 0.094.Conclusion:The more emotional warmth was perceived by the participants, the more systematic they were in their perception of the environment, in turn being more resilient. The study findings help in establishing protective psychological factors in dissociative disorder.

Pathways to care and reasons for treatment-seeking behavior in patients with opioid dependence syndrome: An exploratory study

Background: Magnitude of the menace of opioid dependence syndrome (ODS) is ever escalating especially in Northern India. However, no studies have been attempted to study the pathways to care and reasons for treatment-seeking behavior in patients with ODS. Aim: This study aims to investigate the pathways to care and reasons for treatment seeking in patients with ODS attending the community outreach clinic and de-addiction outpatient department (OPD) of a tertiary care teaching hospital. Materials and Methods: In a cross-sectional, exploratory study, a total of 40 patients diagnosed with ODS as per International Classification of Diseases-10 criteria who visited the psychiatry OPD and community outreach clinic were included. In addition to the sociodemographic and clinical variables, semi-structured questionnaires were developed by the Department of Psychiatry, Government Medical College and Hospital (GMCH), Chandigarh, India, for this study. These were first used in a pilot study and then used for the assessment of reasons for seeking treatment and pathways to care from a particular setting that is either community outreach clinic or OPD. Results: Index study found out that 25% ODS patients attended OPD directly for the first time ever in their life for treatment and 55% attended community outreach clinic run by the Department of Psychiatry, GMCH, Chandigarh, India. For 30% and 35% of the individuals attending OPD and Community outreach clinic, respectively, the first point of contact ever in life since the first use of opioid was any other tertiary care center. Alternative medicine practitioners were consulted by about 20% of the patients seeking help for the first time from OPD and none amongst those attending community outreach clinic. Referral rate was also very low in OPD attending sample (20%) while absolute zero in the community sample. Whereas among reasons for seeking treatment, increasing drug cost was the most cited reason by OPD attending patients and ill-health effects by community clinic attending patients (35% each) in personal reasons, while family-related reasons were poor interpersonal relationships with family members in OPD treatment-seeking patients (45%) and family property dispute in community clinic attending patients (35%). Conclusion: It can be concluded from the study that

Relationship between stigma, self-esteem, and quality of life in euthymic patients of bipolar disorder: A cross-sectional study

Background: As per the existing literature (mostly Western), bipolar affective disorder or bipolar disorder (BD) is associated with low self-esteem, high stigma, and poor quality of life (QOL). Aims: The current study aimed to assess stigma, self-esteem, and QOL and to examine their interrelationships in euthymic patients of BD in the Indian settings. Settings and Design: This hospital-based, cross-sectional study was conducted in a tertiary care hospital in Delhi over a period of 12 months. Subjects and Methods: Sixty-two adults with BD (as per the International Classification of Diseases-10 criteria) in remission were selected. Stigma, self-esteem, and QOL were assessed using the Internalized Stigma of Mental Illness (ISMI) scale, Rosenberg Self-esteem Rating Scale, and World Health Organization (WHO) QOL-BREF, respectively. Statistical Analysis Used: Data were analyzed using Student's t-test, Pearson's correlation coefficients, and multiple regression model. Results: Thirty-two percent of patients did not experience stigma (ISMI total score