Assessment of psychological distress pattern & its correlates among people receiving COVID-19 vaccination during the COVID-19 pandemic: A cross-sectional study

Background & objectives: There is a possibility that vaccinated people may experience lesser psychological distress due to the sense of safety felt by them against getting the COVID-19 infection as compared to those who are not vaccinated. However, there is a paucity of research examining the mental health status of this important sub-group of population. Thus, the present study was aimed to examine the pattern of psychological distress and its correlates among people receiving COVID-19 vaccine. Methods: This cross-sectional study assessed individuals receiving COVID-19 vaccine at a tertiary care hospital. Psychological distress and COVID-19-related anxiety were assessed using the Depression Anxiety Stress Scale (DASS-21) and the COVID-19 Anxiety Scale-7, respectively. Results: The study comprised 728 individuals with a mean age of 44.8 yr. Moderate levels of depression, anxiety and stress were reported by about 50, six and 15 per cent of the participants, respectively, as assessed on DASS-21. Generalized linear model and quantile regression analyses revealed COVID-19-related anxiety, and being a healthcare worker or front-line worker as significant correlates of psychological distress. Interpretation & conclusions: About half of the study participants receiving COVID-19 vaccine reported moderate to severe symptoms of depression. Strategies focusing on alleviation of COVID-19-related fear and anxiety might be effective in improving the symptoms of psychological distress

Learning from telepsychiatry during COVID-19 pandemic in India: Boon for public mental health in low- & middle-income countries

Novel coronavirus disease (COVID-19) pandemic has affected the mental well-being of the population and posed many challenges in availing mental healthcare. Telepsychiatry has been proven to be an effective route for the delivery of mental healthcare. We share our experience of using the telemedicine approach in providing mental health services at a tertiarycare hospital in India during the COVID-19 pandemic, following the break in routine outpatient services during the national lockdown. The telepsychiatry approach helped in ensuring the maintenance of mental healthcare. The utility of telepsychiatry as an option for such future situations and for its use in routine follow up care in indicated cases, have also been discussed.

Workplace based clinical procedural skills assessment using directly observed procedural skills in interns in Otorhinolaryngology rotation

Background: In view of changing requirements in healthcare systems and planned reforms of medical education curricula, effective teaching and assessment of clinical skills in the undergraduate setting has become more and more important. There is a need for implementation of newer methods of evaluation keeping in mind the principles of adult learning and self-directed learning. DOPS (directly observed procedural skills) is a highly structured assessment tool for assessment of the practical work performed by a trainee on a real patient under supervision of experienced faculty. This study aimed to make use of DOPS as a method of workplace based assessment for interns in otorhinolaryngology posting.Methods: 15 interns posted in department of otorhinolaryngology participated in the study. Three clinical procedural skills included were anterior rhinoscopy, otoscopy and indirect laryngoscopy. Three DOPS were undertaken for each skill. The performance was noted as DOPS ratings. The results were tabulated and statistically analysed.Results: A total of 135 DOPS were undertaken for 15 interns. Mean overall DOPS rating improved from DOPS 1 to DOPS 3. The difference in value between DOPS 1 and 3 for anterior rhinoscopy was statistically significant. For otoscopy and indirect laryngology, the difference between DOPS 1 and 2, DOPS 1 and 3 was statistically significant. Both faculty and interns found DOPS to be an efficient tool for assessment.Conclusions: DOPS  is a cost effective assessment tool. It has an effective role in facilitating students’ learning and skill development as it is based on the direct observation of trainees’ procedural skills in real clinical environment.

Stress and emotion regulation in resident doctors at a tertiary care hospital of North India

Background: The stress of medical training stems from academic pressure, exhausting work hours and striving for perfectionist standards. The demanding nature also requires involvement with emotionally draining aspects of life (human suffering, death, sexuality and fear). This may impair quality of life of medical students and influence patient care. As a consequence, post graduate medical students can experience an alarming amount of stress-associated anxiety, depression, substance abuse, and even suicide. Chronic stress is also known to influence memory, learning and especially problem-solving abilities which require flexible thinking. The study was carried out to evaluate the relationship of stress to cognitive reappraisal and emotion suppression in post graduate medical students. Methods: 150 post graduate medical students participated in the study. Emotion Regulation Questionnaire and Professional Life Stress Questionnaire were administered on each participant. Data collected was kept confidential. Results were tabulated and statistically analysed.Results: Out of 150 participants, 85 (56.67%) experienced stress. 65 (43.33%) participants had stress in the moderate range, 20 (13.33%) participants had stress in the problematic area for whom remedial action was required. 52% showed high cognitive reappraisal, while 54% showed emotional suppression.Conclusions: The correlation between stress, cognitive reappraisal and between stress, emotion suppression showed weak strengths.

Very-late Onset Mania Episode: Case Report and Review of Cases Over 75 Years of Age

Introduction: Bipolar I disorder typically characterized bycycles of depression and mania. Onset after the age of 75 yearsis very rare and the reported incidence of mania is 2/100000,which most often occur due to secondary organic aetiology.Here we are presenting a review and an interesting case oflate-onset first episode mania while evaluating and excludingall other secondary causes of mania.Case Report: 79-year-old male presented with 2 weeks’duration of illness and symptoms was suggestive of a manicepisode. The patient was thoroughly assessed with laboratoryinvestigations and non-contrast computerised tomography(NCCT) brain to find any secondary causes of mania butnothing was significant. Finally, as per tenth revision of theInternational Statistical Classification of Diseases (ICD-10)diagnosis of first episode Mania without psychotic symptoms(F30.1) was made. He was started on Valproate which wasgradually increased up to 750 mg/day and olanzapine 5mg.After 6 weeks, the YMRS score decreased from 32 to 8 and heachieved his premorbid functioning level.Conclusion: This case highlights that primary psychiatryillness can occur at any age but in the geriatric populationbefore finalizing the diagnosis all other secondary causesshould be ruled out. There is a high need for systematicresearch in this area to formulate effective managementguidelines in the geriatric population.

Presentation And Management Of Bilateral Fracture Shaft Humerus In A Multiple Myeloma Patient: An Extremely Rare Case Report And Review Of Literature

Multiple myeloma (MM) is a malignancy of plasma cells and the second most common hematologic malignancy (13%); these cells accumulate in bone marrow and overproduce a monoclonal protein. The bone disease develops in 80–90% of patients with MM includes bone pain, pathologic fractures (40%), spinal cord compression (5%), and hypercalcemia. Pathological fractures can occur in extremities, but bilateral involvement is extremely rare. We report a case of 65-year-old male presented with a chief complaint of spontaneous bilateral humerus shaft fractures. On subsequent workup, MM was confirmed. The patient was managed with internal fixation bilaterally and showed favorable union at 1-year follow-up

An Assessment of the Level of Awareness, Attitudes, Opinions of Pharmacy Students Concerning HIV and AIDS in Malaysia.

Aims: HIV and AIDS spreading wide and causing serious threats and deaths among Malaysian residents. A nationwide cross-sectional survey was conducted to assess the awareness, attitudes and opinions about HIV and AIDS among pharmacy students. Methods: A total of 316 pharmacy students of year three and onwards took part in the survey. Students were asked to fill in questionnaires with consent forms. The results were analyzed by using SPSS version 17. Results: The data indicated that awareness about HIV and AIDS was moderate. High level of awareness was seen for major routes of HIV transmissions, but lower level of awareness was seen for other modes of transmission like circumcision, visiting barbers, and blood splashes on outer body surface. Only 19.3% and 13.3% of respondents were aware about HIV prevention by sex abstinence and by staying faithful to one partner respectively. The respondents had doubts in keeping HIV and AIDS patients in close vicinity to them and their family. Conclusion: According to the findings, the respondents had a few misconceptions about HIV transmission and prevention. Data from this survey may be useful to hold programs and campaigns designed to convey accurate information about HIV transmission and prevention. Talks and media campaigns should also be carried out to change their attitudes and opinions about HIV and AIDS.

Association of corpus callosum agenesis with mental retardation and attention deficit hyperactivity disorder.

Aims: Anomalies of the corpus callosum have been associated with varied brain and somatic malformations. It has been associated with diverse genetic causes with identifiable syndromes. We aim to report a case of corpus callosal agenesis (CCA) associated with mental retardation and hyperactivity. Presentation of case: We report case of a 7 year old boy having CCA, abnormal facial morphological features, mental retardation and attention deficit hyperactivity disorder (ADHD), devoid of any chromosomal rearrangements or somatic malformations known to be associated with corpus callosal changes. Discussion: Symptoms in CCA are often related to concurrent migrational disorders, not to the callosal anomaly itself. Although multiple genetic etiologies have been associated, no single gene has been proved to be implied in all cases of CCA. Conclusion: This case highlights importance of recognizing mental retardation and ADHD as a presentation of isolated CCA which may occur without any known chromosomal malformation.

Anxiety and Depression amongst the urban females of Delhi in Ante-partum and Post-partum period.

Objectives: To assess and compare the prevalence of anxiety and depression during and after pregnancy. Methodology: This cross sectional study was done in an inpatient setting in Department of Gynecology and Obstetrics in a tertiary level multi-specialty hospital in Delhi, India over a period of nine months.Two groups of women were studied. Group 1 sample included all pregnant women in last trimester awaiting delivery and Group 2 included the women in postpartum period (4-12 weeks after childbirth). Hospital Anxiety & Depression scale (HADS) was used to assess anxiety & depressive symptoms. Results: Of the 100 women included, 59% were awaiting delivery and 41% were in postpartum. The mean age was 23.87 years (SD 3.19), and both the groups were comparable on socio-demographic parameters. Of currently pregnant women 27% & 17% scored above cut-off on anxiety and depression scale respectively while amongst postpartum females 17% scored above cut-off on anxiety and depression scales. Both groups differed significantly (p<0.05) on the total HADS score and Anxiety subscale scores of HADS. There was no significant difference amongst the groups on Depression subscale scores. Conclusions: Prevalence of anxiety and depression is high amongst women during antepartum and postpartum periods. Pregnant women experience more anxiety during ante partum period as compared to post partum period and most of them are not being monitored during this time.

Efficacy and Tolerability of Escitalopram for Treating Depression in Parkinson’s Disease.

Introduction: Despite the frequently coexistence and prominent negative effect of depression in Parkinson’s disease, there is currently no evidence-based standard of care. Objective: The purpose of this study was to examine the efficacy and tolerability of individually administered selective serotonin reuptake inhibitor (SSRI) - escitalopram, relative to clinical monitoring (with no new treatment), for depression in this medical population. Method: In this retrospective open label analysis of 28 depressed (based on ICD-10 criteria and Mini International Neuropsychiatric Interview) patients with Parkinson’s disease were treated with escitalopram 10-20 mg/d for duration of 8 weeks. The Hospital Anxiety and Depression Scale (HADS) depression subscale score and Clinical Global Impression-Improvement (CGI-I) score was the primary outcome. Assessments were completed at baseline, 4 (midpoint) and 8 (end of treatment) weeks of follow-up evaluation. Results: Although treatment was well tolerated and correlated with a significant decrease in HADS and CGI score, response and remission rates were 43.4% and 57.2%, respectively. Conclusions: Escitalopram may be a viable approach for the treatment of depression in Parkinson’s disease. Further research is needed to replicate and extend these findings.