Eficácia de la Terapia Cognitiva Conductual Para el Trastorno Bipolar: una Revisión Sistemática

Introducción: El trastorno bipolar (TB) es una enfermedad mental grave con un curso crónico y una morbimortalidad importante. El TB tiene una tasa de prevalencia a lo largo de la vida del 1 al 1,5% y se caracteriza por episodios recurrentes de manía, depresión o una mezcla de ambas fases. Aunque tiene tratamiento farmacológico y psicoterapéutico, la terapia cognitiva conductual (TCC) ha mostrado efectos beneficiosos, pero no se cuenta con suficiente información clínica en la literatura actual. Métodos: El objetivo principal es determinar la eficacia de la TCC sola o como complemento del tratamiento farmacológico para el TB. Se realizó una revisión sistemática de 17 artículos. Los criterios de inclusión fueron: investigación cuantitativa o cualitativa dirigida a examinar la eficacia de la TCC en pacientes con TB con/sin medicación, publicaciones en idioma inglés y tener 18-65 anos de edad. Los criterios de exclusión fueron: artículos de revisión y metanálisis, artículos que incluían a pacientes con otros diagnósticos además de TB y no separaban los resultados basados en dichos diagnósticos y estudios con pacientes que no cumplían los criterios de TB del DSM o ICD. Se realizaron búsquedas en las bases de datos PubMed, PsycINFO y Web of Science hasta el 5 de enero de 2020. La estrategia de búsqueda fue: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". Resultados: Se incluyó en total a 1.531 pacientes de ambos sexos. La media de edad ponderada fue 40,703 arios. El número de sesiones varió de 8 a 30, con una duración total de 45-120 min. Todos los estudios muestran resultados variables en la mejora del nivel de depresión y la gravedad de la manía, mejora de la funcionalidad, disminución de recaídas y recurrencias, reducción de los niveles de ansiedad y reducción de la gravedad del insomnio. Conclusiones: Se considera que la TCC sola o complementaria para pacientes con TB muestra resultados prometedores después del tratamiento y durante el seguimiento. Los beneficios incluyen niveles reducidos de depresión y manía, menos recaídas y recurrencias y niveles más altos de funcionamiento psicosocial. Se necesitan más estudios.

Introduction: Bipolar disorder (BD) is a serious mental illness with a chronic course and significant morbidity and mortality. BD has a lifetime prevalence rate of 1% to 1.5% and is characterised by recurrent episodes of mania and depression, or a mixture of both phases. Although it has harmacological and psychotherapeutic treatment, cognitive behaviouraltherapy (CBT) has shown beneficial effects, but there is not enough clinical information in the current literature. Methods: The main aim was to determine the efficacy of CBT alone or as an adjunct to pharmacological treatment for BD. A systematic review of 17 articles was carried out. The inclusion criteria were: quantitative or qualitative research aimed at examining the efficacy of CBT in BD patients with/without medication; publications in English language; and) being 18-65 years of age. The exclusion criteria were: review and meta-analysis articles; articles that included patients with other diagnoses in addition to BD and that did not separate the results based on such diagnoses; and studies with patients who did not meet the DSM or ICD criteria for BD. The PubMed, PsycINFO and Web of Science databases were searched up to 5 January 2020. The search strategy was: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". Results: A total of 1,531 patients both sexes were included. The weighted mean age was 40.703 years. The number of sessions ranged from 8-30, with a total duration of 45120 minutes. All the studies show variable results in improving the level of depression and the severity of mania, improving functionality, reducing relapses and recurrences, and reducing anxiety levels and the severity of insomnia. Conclusions: The use of CBT alone or adjunctive therapy in BD patients is considered to show promising results after treatment and during follow-up. Benefits include reduced levels of depression and mania, fewer relapses and recurrences, and higher levels of psychosocial functioning. More studies are needed.

Intentions and Behavioural Determinants in the Face of COvID-19 Pandemic: A Theory of Planned Behaviour and Risk Perception Model / Intenciones y determinantes del comportamiento ante la pandemia de COvID-19: un modelo de teoría del comportamiento planificado y percepción del riesgo / Intenções e determinantes do comportamento diante da pandemia de COvID-19: um modelo teórico de comportamento planejado e percepção de risco

The containment of COVID-19 implied challenges for governments and health authorities to motivate citizens to adopt several prevention behaviours (i.e., wearing a face mask and washing hands frequently). This paper aims to identify the factors that encourage people to adopt these behaviours. Our analysis was conducted over data collected by ASCOfAPSI and the Universidad Autónoma de Barcelona about attitudes and beliefs related to the pandemic from 919 people from Colombia. The data was collected using an online snowball sampling between May and June 2020. We found that each prevention behaviour is motivated by a different set of factors. Specifically, based on the theory of planned behaviour, our results suggest that the intention to adopt a preventive behaviour is pre- dicted by a group of variables about subjective norms and attitudes as independent variables and another one linked to perceived control as mediator variables. This suggests that the motivation for prevention behaviours from authorities should be particular to each behaviour and consider the associated particular pattern of motivations and the sociodemographic characteristics and possibilities of action.

La contención del COVID-19 implica desafíos para los gobiernos y las autoridades de salud pública, a fin de motivar a los ciudadanos a que adopten las conductas de prevención (i.e., usar tapabocas, lavarse las manos frecuentemente). El propósito de este artículo es identificar los factores que motivan a las personas a adoptar tales conductas. Nuestro análisis se realizó con datos recolectados por ASCOfAPSI y la Universidad Autónoma de Barcelona sobre actitudes y creencias acerca de la pandemia de 919 personas de Colombia. Con este análisis encontramos que cada clase de conducta de prevención está motivada por un conjunto de factores diferentes. Específicamente, asumiendo la teoría de la acción planeada, nuestros resultados dan soporte a la tesis de que la intención de adoptar un tipo de conducta de prevención está predicha por un conjunto de variables sobre normas subjetivas y actitudes como variables in- dependientes y un conjunto de variables vinculadas al control comportamental percibido como variables mediadoras. Esto sugiere que la motivación hacia las conductas de prevención por parte de las autoridades debería ser particular a cada tipo de conducta de prevención, y debería considerar el patrón de motivación particular asociado, así como particularidades sociodemográficas y diferentes posibilidades de acción.

A contenção do COVID-19 implica desafios para governos e autoridades de saúde pública para motivar os cidadãos a adotar comportamentos preventivos (i.e., usar máscaras faciais, lavar as mãos com frequência). O objetivo deste artigo é identificar os fatores que motivam as pessoas a adotar tais comportamentos. Nossa análise foi realizada em dados coletados pela ASCOfAPSI e pela Universidade Autônoma de Barcelona sobre atitudes e crenças sobre a pandemia de 919 pessoas da Colômbia. Com esta análise, descobrimos que cada classe de comportamento de prevenção é motivada por um conjunto diferente de fatores. Especificamente, assumindo a teoria da ação planejada, nossos resultados suportam a tese de que a intenção de adotar um tipo de comportamento de prevenção é predita por um conjunto de variáveis sobre normas sub- jetivas e atitudes como variáveis independentes e um conjunto de variáveis ligadas ao controle comportamental percebido como variáveis mediadoras. Isto sugere que a motivação para comportamentos de prevenção por parte das autoridades deve ser particular a cada tipo de comportamento de prevenção e deve considerar o padrão particular de motivação a ele associado, bem como particularidades sociodemográficas e diferentes possibilidades de ação.

Effectiveness of “Oral Health Care for Children with Autism Spectrum Disorder Module” in Improving Tooth-Brushing Practice among Children with Autism Spectrum Disorder in Hospital Universiti Sains Malaysia

@#Introduction: Autism spectrum disorder (ASD) is associated with behavioural problems which may affect children’s oral health statuses. Caregivers have crucial roles in caring for these children’s oral health. Thus, this study is aimed to evaluate the effectiveness of the Oral Health Care for Children with ASD (OHASD) Module in improving caregivers’ tooth-brushing difficulties in children ASD. Methods: Quasi-experimental study on caregivers of children with ASD aged 7 to 12 years who were registered at the Psychiatry Clinic Hospital Universiti Sains Malaysia (USM), Kelantan. The sociodemographic data obtained, and behavioural problems were assessed. Tooth-brushing difficulties were evaluated at pre- and six months post-intervention using OHASD Module. Data were analysed using IBM SPSS 26.0. Results: A total of 32 Malay children with ASD including their caregivers participated in this study. Caregivers were mostly mothers (78.1%) and children were mostly boys (84.4%), with mean age (SD) of 39.1 (4.19) and 8.8 (1.52) years respectively. Parent-reported questionnaire using the Modified Checklist for Autism in Toddlers (M-CHAT) showed 65.6% of children were highly sensitive to noises, 53.1% sometimes stared at nothing or wandered without purpose and 59.4% were unable to imitate caregivers’ faces. Significant differences between pre- and post-intervention for items; children who liked to close their mouths, turn their heads in different directions, did not understand the purpose of tooth-brushing (P<0.05). Conclusion: OHASD Module is useful in assisting caregivers in practising daily tooth-brushing of children with ASD.

Masturbación compulsiva en adolescente / Compulsive Masturbation in Adolescents

Introducción: La masturbación compulsiva provoca una cascada de sentimientos y emociones que pueden recorrer desde la culpabilidad y el rechazo a la satisfacción hasta el bienestar más placentero y deseado. Objetivo: Exponer una forma de presentación poco frecuente de un adolescente con masturbación compulsiva. Presentación del caso: Adolescente masculino de 14 años de edad, de procedencia rural y antecedentes de salud física. Evaluado en consulta de psiquiatría infanto - juvenil por realizar masturbaciones en sitios públicos, que resultaban cada vez más frecuentes, y al final de esta se producía expulsión de materia fecal. Los estudios clínicos y psicométricos confirmaron el diagnóstico de masturbación compulsiva. Conclusiones: El tratamiento se basó en el modelo cognitivo-conductual y farmacológico con imipramina. Se disminuyó la frecuencia e intensidad, así como la duración de la conducta problema. El caso clínico expuesto resulta de interés por ser poco frecuente la presencia de este trastorno dentro de la población adolescente(AU)

Introduction: Compulsive masturbation provokes a cascade of feelings and emotions that can range from guilt and refusal to satisfaction to the most pleasurable and desired well-being. Aim: To present a rare presentation of an adolescent with compulsive masturbation. Case presentation: 14-year-old male adolescent from a rural area with a history of previous physical health. He was evaluated in a child and adolescent psychiatry clinic for masturbation in public places, which became increasingly frequent and ended with the expulsion of fecal matter. Clinical and psychometric studies confirmed the diagnosis of compulsive masturbation. Conclusions: Treatment was based on the cognitive-behavioral and pharmacological model with imipramine. The frequency and intensity, as well as the duration of the problem behavior was reduced. The clinical case presented was of interest due to the infrequent presence of this disorder in the adolescent population(AU)

Molecular diversity of genes related to biological rhythms (period and timeless) and insecticide resistance (Na V and ace-1) in Anopheles darlingi

BACKGROUND Malaria is a public health concern in the Amazonian Region, where Anopheles darlingi is the main vector of Plasmodium spp. Several studies hypothesised the existence of cryptic species in An. darlingi, considering variations in behaviour, morphological and genetic aspects. Determining their overall genetic background for vector competence, insecticide resistance, and other elements is essential to better guide strategies for malaria control. OBJECTIVES This study aimed to evaluate the molecular diversity in genes related to behaviour and insecticide resistance, estimating genetic differentiation in An. darlingi populations from Amazonian localities in Brazil and Pacific Colombian region. METHODS We amplified, cloned and sequenced fragments of genes related to behaviour: timeless (tim) and period (per), and to insecticide resistance: voltage-gated sodium channel (Na V ) and acetylcholinesterase (ace-1) from 516 An. darlingi DNA samples from Manaus, Unini River, Jaú River and Porto Velho - Brazil, and Chocó - Colombia. We discriminated single nucleotide polymorphisms (SNPs), determined haplotypes and evaluate the phylogenetic relationship among the populations. FINDINGS The genes per, tim and ace-1 were more polymorphic than Na V . The classical kdr and ace-1 R mutations were not observed. Phylogenetic analyses suggested a significant differentiation between An. darlingi populations from Brazil and Colombia, except for the Na V gene. There was a geographic differentiation within Brazilian populations considering per and ace-1. CONCLUSIONS Our results add genetic data to the discussion about polymorphisms at population levels in An. darlingi. The search for insecticide resistance-related mechanisms should be extended to more populations, especially from localities with a vector control failure scenario.

Anxiety, depression, and memory loss in Chagas disease: a puzzle far beyond neuroinflammation to be unpicked and solved*

Mental disorders such as anxiety, depression, and memory loss have been described in patients with chronic Chagas disease (CD), a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi. Social, psychological, and biological stressors may take part in these processes. There is a consensus on the recognition of an acute nervous form of CD. In chronic CD patients, a neurological form is associated with immunosuppression and neurobehavioural changes as sequelae of stroke. The chronic nervous form of CD has been refuted, based on the absence of histopathological lesions and neuroinflammation; however, computed tomography shows brain atrophy. Overall, in preclinical models of chronic T. cruzi infection in the absence of neuroinflammation, behavioural disorders such as anxiety and depression, and memory loss are related to brain atrophy, parasite persistence, oxidative stress, and cytokine production in the central nervous system. Interferon-gamma (IFNγ)-bearing microglial cells are colocalised with astrocytes carrying T. cruzi amastigote forms. In vitro studies suggest that IFNγ fuels astrocyte infection by T. cruzi and implicate IFNγ-stimulated infected astrocytes as sources of TNF and nitric oxide, which may also contribute to parasite persistence in the brain tissue and promote behavioural and neurocognitive changes. Preclinical trials in chronically infected mice targeting the TNF pathway or the parasite opened paths for therapeutic approaches with a beneficial impact on depression and memory loss. Despite the path taken, replicating aspects of the chronic CD and testing therapeutic schemes in preclinical models, these findings may get lost in translation as the chronic nervous form of CD does not fulfil biomedical model requirements, as the presence of neuroinflammation, to be recognised. It is hoped that brain atrophy and behavioural and neurocognitive changes are sufficient traits to bring the attention of researchers to study the biological and molecular basis of the central nervous system commitment in chronic CD.

Completers Versus Dropouts of A Parent Training Programme and Child Behaviour Improvement In Malaysia

@#Introduction: There is a strong body of evidence advocating parent training programmes in the management of behavioral problems in children. In these programmes, attrition is a major challenge. We aimed to examine the sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children’s behavioural problems as rated by mothers who completed (PC) and mothers who dropped out (PD) of a parent training programme. We also aimed to determine whether there was any change in their children’s behaviour scores before and after intervention. We hypothesized that parent and child sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children’s behavioural problems would be different between PC and PD, and that children of PC would experience significant improvements in their behaviour. Methods: Data from a randomised controlled trial (RCT) involving 35 mothers and children aged 6–12 years old with behavioural problems who were enrolled in a parent training programme were examined. Child behaviour was measured using the Strength and Difficulties Questionnaire. Results: No significant differences were found between PC and PD in terms of the sociodemographic and clinical profiles, parental motivation, and pre- or post-intervention child behaviour. After programme completion, PC (n=27) reported improvements in all the behaviour subscales; total difficulties (p<0.001), emotional problem (p=0.004), conduct problem (p=0.001), hyperactivity symptoms (p<0.001), peer problems (p=0.036), and prosocial behaviour (p=0.001). Conclusion: The parent training programme produces significant child behaviour improvements in mothers who complete the programme. Nonetheless, the study has some limitations which restrict the generalizability of these findings.

The need for targeted behavioural HIV-related interventions for transgender women in India: A scoping review

Background & objectives: Transgender women (TGW) in India are at high risk of HIV infection. Despite behavioural interventions aimed at reducing HIV risk, no literature synthesis exists so far to evaluate their potential for reducing HIV incidence in India This review was aimed to identify and evaluate HIV-focussed behaviour change interventions for TGW in India. Methods: Literature from three databases were reviewed up to June 2, 2021, for studies describing behavioural interventions for HIV prevention among TGW in India. The inclusion criteria were studies that included TGW and reported intervention effects on HIV prevention-related behaviour. Data were analyzed descriptively. Results: Of the 146 articles screened, only three met the inclusion criteria. All three interventions were at the open pilot trial stage and included other high-risk groups (e.g. men who have sex with men). The interventions used behavioural counselling, increased sexually transmitted infection screening and sexual healthcare visits and leveraged community-based organizations to improve the outcomes. All these interventions showed modest improvements in health-seeking behaviour and access to services. However, none specifically targeted TGW. Interpretation & conclusions: The scoping review highlights the need for behavioural interventions for HIV prevention tailored to TGW in India. This study emphasizes the need for research to move to the next stage of intervention development and testing utilizing more rigorous evaluation methods, such as a randomized controlled trial.

Síntomas conductuales y emocionales de adolescentes que consultan a un programa especializado de trastornos de la conducta alimentaria / Behavioural and Emotional Symptoms of Adolescents Consulting a Specialised Eating Disorders Programme

RESUMEN Introducción: Los trastornos de la conducta alimentaria (TCA) son afecciones complejas de origen multifactorial que tienen como principal característica la preocupación excesiva por el peso y la forma del cuerpo, que causa gran malestar y afectación física llevando a una disminución de la calidad de vida y alteraciones de la funcionalidad del paciente y su entorno social. El objetivo de este estudio es describir los síntomas de orden emocional y conductual de los adolescentes que consultan en la ciudad de Bogotá a un programa especializado en TCA. Métodos: Estudio observacional y descriptivo de corte transversal, para el que se reclutó a pacientes de 11-19 arios con diagnóstico de TCA. Resultados: Se incluyeron 40 pacientes con diagnóstico de TCA, el 92% mujeres. El promedio de edad de los pacientes fue 16,6 ± 1,9 años. El 57% de los pacientes viven en hogar biparental y el 30%, en hogar monoparental. El 72% de la población tenía un rendimiento académico excelente. El 50% de los pacientes estaban moderadamente enfermos. El 60% estaba en tratamiento farmacológico con ISRS. El 65% de los pacientes cumplían criterios clínicos de trastorno de ansiedad; el 30%, de trastorno depresivo; el 22,5%, de problemas de agresividad, y el 17,5%, de conducta delictiva. El 72,5% de la muestra muestra criterios clínicos de síntomas internalizantes y el 42,5%, de síntomas externalizantes, y la mayoría de ellos son pacientes con diagnóstico de bulimia nerviosa. Conclusiones: Los pacientes con bulimia nerviosa obtuvieron en los diferentes síntomas de orden emocional y conductual puntuaciones superiores que con los demás trastornos alimentarios. Esta entidad ofrece mayor psicopatología, la cual se debe examinar rigurosamente al momento de la atención clínica, buscando disminuir el impacto funcional que estos síntomas generan en el individuo.

ABSTRACT Introduction: Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. Methods: Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. Results: Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6 ± 1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. Conclusions: Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.

Underlying factors influencing street food vendors' implementation of food safety behaviours

This study aimed to determine the underlying factors influencing street food vendors' implementation of food safety behaviours related to food handling. A questionnaire based on the Theory of Planned Behaviour was applied to 303 street food vendors in Southern Brazil. Open-ended questions identified that consequences related to consumers were important factors influencing street food vendors' food safety behaviour. Also, water supply and lack of water were identified, respectively, as possible facilitators and barriers to carry out food safety behaviours such as handwashing and cleaning the shelf used to prepare food. Optimistic bias was identified and the majority of street food vendors gave positive results related to perceived behavioural control, subjective norm, attitude and behavioural intention. Improvements are needed in government regulation, infrastructure and food safety training for this sector, with measures that reflect and are adapted to the street food environment.

Este estudio tuvo como objetivo determinar los factores subyacentes que influyen en la implementación del comportamiento de seguridad de los alimentos en la manipulación de alimentos por vendedores ambulantes de alimentos. Se aplicó un cuestionario basado en la Teoría del Comportamiento Planificado a 303 vendedores ambulantes de alimentos en el sur de Brasil. Las preguntas abiertas identificaron que las consecuencias relacionadas con los consumidores eran factores importantes que influían en el comportamiento de seguridad de los alimentos por parte de los vendedores ambulantes de alimentos. También se identificaron el suministro de agua y la falta de agua, respectivamente, como posibles facilitadores y barreras para realizar comportamientos de seguridad de los alimentos como lavarse las manos y limpiar la mesa de trabajo que utilizan para preparar los alimentos. Se identificó sesgo optimista y la mayoría de los vendedores ambulantes de alimentos dieron resultados positivos relacionados con el control conductual percibido, la norma subjetiva, la actitud y la intención de comportamiento. Se necesitan mejoras en la regulación gubernamental, la infraestructura y la capacitación en seguridad de los alimentos para el sector, con medidas que reflejen y se adapten al entorno de la comida callejera.

A Cross Sectional Study on Assessment of Cognitive Impairment and Behavioural Risk Factors Among Senior Citizens Living in Old Age Homes in Chengalpattu District, Tamilnadu

Background: Ageing is an irreversible, unavoidable, universal phenomenon accompanied by gradual reduction in functional capacity of the elderly. The number of elderly populations in India is expected to triple reaching 2 billion. This study aims to estimate the prevalence of cognitive impairment and evalu- ate the association between various socio demographic and behavioural risk factors. Methodology: This descriptive cross-sectional study was carried among 330 senior citizens living in old age homes by using a two-stage multistage sampling method. A standardized pretested structured ques- tionnaire containing Brief Interview for Mental Status (BIMS) scale was used. Data was analysed using SPSS (Version 22). Results: Among 330 study respondents, around 44% had mild -to- moderate cognitive impairment and 36% had severe cognitive impairment. Nearly 74.8% have their habit of regular physical activity. Among the study subjects approximately 4% of them were current smokers, 5.2% had the habit of regular alco- hol consumption previously. Conclusion: Integration of NPHCE and NMHP can be beneficial in early diagnosis of mild cognitive im- pairment during weekly outpatient visits at PHC. Level of attention given towards Alzheimer’s disease (AD) is more when compared to screening for cognitive impairment which is an early precursor for AD.

Epidemiological Determinants of Leprosy in a High Endemic District of India: A Community Based Case Control Study

The leprosy elimination at national level was achieved in India in December 2005, however, Chhattisgarh is the only State yet to achieve same at State level and reported highest ANCDR/100000 population, i.e., 29.7 as on 31st March 2020. The efforts of the National Leprosy Eradication Programme (NLEP) are admirable wherein several initiatives introduced in phased manner since 2015, but there is need to understand the local scenario for effective control of this chronic disease in Chhattisgarh. This study conducted to identify various socio- demographic, behavioural, environmental factors associated with leprosy occurrence in high endemic district named Raipur. A community-based case control study design was adopted with inclusion criteria for cases as diagnosed, confirmed, and classified leprosy patients as per the WHO recommendation and NLEP Guidelines and controls as matched with cases' sex, age, (excluding the family members) and inhabiting same local area. Total 448 cases and 439 controls were interviewed from the district, after stratification of blocks based on G2D percentage among new cases detected & distribution of the sample (meant to be drawn from district) in proportion to the new cases reported by each stratum during year 2019. Data regarding socio-demographic profile, personal practices, disease profile & case history was collected through 2 different predesigned schedules. Descriptive, stratified analysis was performed along with chi square test score calculation for each variable. Further, bivariate & multinomial logistic regression was done to calculate adjusted odds ratio (for religion, age, caste, gender, education, occupation, residential area, family income) as measure of association. Low education level, absence of windows and safe water supply in household, use of same towel by multiple family members and history of contact with leprosy patients in family/ friends were found to be significantly associated with leprosy occurrence. The interventions targeted against these factors, i.e., emancipation of education level, IEC for hygiene, ventilation etc. may help in curbing the leprosy transmission in this high endemic district and other districts facing the same menace.

Behavioural Finance - A Review Paper

The current research examines the evolution of behavioural finance over the span of financial history. It contains the earliest records of stock market behaviour oddities recorded by researchers. Traditional finance is discussed first, followed by an examination of traditional ideas in instances when they are judged inadequate. The study then discusses the importance of behavioural finance and its key role in creating a connection between real-world scenarios and classical assumptions.

A cross sectional study on Emotional status and Behavioral Changes of school going children during the COVID-19 outbreak

Background: The current threat of Covid-19 pandemic is not only disrupting the economy but also creating psychological impact on the people. As a measure to control the spread, India imposed lockdown on various occasions. During this period only essential services were operational, while educational institutions remain closed. Due to social distance norms and restricted recreational activities, children are more prone to behavioural changes and it can also cause anxiety and depression. The current study focusses upon this aspect among school going children due to Covid-19.. Methodology: A cross sectional study was done on school going children, currently restricted to home. A semi-structured questionnaire which included (RCADS-25 scale for depression and anxiety) was administered to the parents through online platform. Bivariate logistic regression was used to test the significance of association between changes Impact of covid-19 and emotional status of Children and also between behavioural changes in children and presence of at least one sibling. Results: Majority of respondents were males (59%) and mean age was 9.9yrs. Majority (47.2%) belong to Middle school. Mean score of RCADS-25 scale was 15.61±9.4 for the study population. Worry was seen in 67.3% and frustration was seen in 32.4% for conduction of online classes. Irritability was seen 31.91% and restriction of outdoor activities caused loss of temper in 56.9% of the study population. Insomnia was often seen in 20% while 50% had sadness/empty feeling at some point of time. Lack of confidence was seen in 52.7% children. Majority (69.5%) were scared to sleep alone at night. Chi-square test for significance showed significant association between Parent’s behaviour and mood changes in Children (O.R- 2.43(1.1-5.33 - 95%C. I) p=0.04). Bivariate logistic regression showed significant association between Impact of covid-19 and emotional status of Children (O.R=2.967,95% C.I(1.582-5.564), p=0.001) and also between behavioural changes during pandemic and presence of at least one sibling(O.R =0.578,95% C.I 0.345-0.971,p=0.038). Conclusion: The behavioural changes of children due to Covid -19 is evident and necessary measures like counselling the parents are necessary

Emerging Personality Disorder – management and treatment applying Dialectical Behavioral Therapy: a case study

It is of essential importance to identify clinical conditions of childhood and adolescence that present a high risk to evolve any kind of Personality Disorder. Personality disorder does not suddenly come out at age eighteen years old. Early sighs of some pathological behaviour that evolves before 19 years predict long term deficits in functioning and a higher chance is there these patients continue to present some symptoms up to 20 years. Some childhood and early adulthood predictive factors are responsible for excellent recovery of Personality disorder. Unfortunately, PD diagnosis and treatments both gets delayed. Adolescence represents a sensitive and vulnerable phase for the development of any kind of Personality Disorder. There is a dearth of information about emerging personality development in childhood and in adolescence. The present study attempts to explore the role of Dialectical Behavioural Therapy in the management of a 14 years old Female, Hindu, Bengali speaking, Unmarried, hailing from an urban neutral family with a diagnosis of emerged personality disorder with prominent features of impulsivity, interpersonal relationship problems, self-harm behaviours, anger outbursts. Thus the aim of the present study is to reduce these behaviours which is having an impact in her life and improving overall well-being of the individual. She was treated with DBT approach, bringing in improvement after 14 sessions.. The execution of DBT for suicidal adolescent has been presented by a case study.

Understanding the Behavioral Problems and Oral Health Status of Children With Autism Spectrum Disorder: A Narrative Review

@#Autism Spectrum Disorder (ASD) is a neurodevelopment disorder with an unidentified etiology and wide-ranging functional impact. This narrative review aimed to identify various behaviours and oral health problems among children with ASD, recognize the barriers towards oral health care, and identify the strategies for oral health care management. Online databases (Scopus, PubMed and Google Scholar) were used by using various search terms. All types of articles with different level of evidence were included. Articles which were not in English and were not available in full text were excluded. Various behavioural problems among ASD contributed to various oral healthcare challenges that lead to compromise oral health status. Caregivers and dental professionals have to identify these problems towards strategizing an effective oral health management for them. Therefore, this narrative review provide an insight towards controlling the oral health problems faced through preventative and practical approach for the chidlren with ASD.

Factors Correlated With Internet Gaming Disorder Among Malaysian University Students

@#Introduction: Internet gaming disorder (IGD) has recently been incorporated into the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) as a disorder for future research. The primary objectives of the present study are to describe the level of IGD and to examine its correlations with sociodemographic factors and psychological comorbidities among undergraduate students in a Malaysian university. Methods: A total of 411 undergraduate students completed an online questionnaire. They were selected from a random sample of participating university faculties. The online questionnaire contained the Internet Gaming Disorder Scale-Short-Form and the Depression, Anxiety, Stress Scale. Results: The presents study reported that 52.8% of the participants had high IGH. Using hierarchical multiple regression, age (β = -0.09, p < 0.05), gender (β = -0.40, p < 0.001) and stress (β = 0.23, p < 0.05) were statistically significant predictors of IGD. Academic performance, depression and anxiety did not emerge as significant predictors. Conclusion: These findings highlight the risk factors (in particular, stress) of IGD. Further studies on interventions, particular that of preventative strategies, will be needed to combat this emerging public health problem.

Understanding Matters of the Mind in Obesity

@#Obesity is a growing global concern, and Singapore is not spared from the global epidemic. Apart from the increased risk for many serious diseases and health conditions, obese individuals are vulnerable to many psychological comorbidities. Obesity management through lifestyle changes can be limited by various barriers, increasing the challenge of implementation and leaving some clinicians feeling frustrated and stressed. The paper examines the barriers identified in the literature, discusses the use of cognitive behavioural concepts and techniques to facilitate the lifestyle change process and explores the use of motivation and readiness to change to guide the clinician’s strategies.

Anxiety Disorders - Assessment and Management in General Practice

@#The objective of this article is to provide an update on the diagnosis, assessment, and management of anxiety disorders in adults. This article covers the following disorders: panic disorder, panic attacks, specific phobia, social anxiety disorder and generalized anxiety disorder. Selective mutism and separation anxiety disorder, being childhood anxiety disorders, will not be covered. Obsessive compulsive disorder and post-traumatic stress disorder, which are not categorized as anxiety disorders in DSM-5, will not be covered. Anxiety and related disorders are common mental health disorders but are under-diagnosed and undertreated. Most cases of anxiety disorders present first to the primary care physician and can be managed in primary care. It is important to take a detailed history of the patient’s symptoms and their severity and duration, enquire about psychosocial stressors, as well as symptoms that may be suggestive of a medical condition and also to assess suicidality. A combined approach of psycho-education, relaxation training, and medications give the best results. SSRIs are first line pharmacologic treatment for most anxiety disorders. There is a need to stress that benzodiazepines have no role in the longterm treatment of anxiety disorders. They should not be given for more than 2 to 4 weeks. Treatment for generalized anxiety disorder should be for at least 32 weeks as high relapse rates are reported after discontinuing medications.

¿Trastorno de conducta o trastorno de personalidad límite? La importancia de la intervención precoz

El diagnóstico de trastorno de personalidad límite en la adolescencia suele ser un tema controvertido. A continuación se presenta un caso clínico que expone las características habituales de presentación en la adolescencia y se discute además la necesidad de tener en cuenta los factores precursores del trastorno de personalidad límite a la vez que se relaciona la presencia de determinados trastornos de conducta como futuros precursores. Se insiste en la necesidad de usar programas de intervención precoz para este tipo de pacientes con los modelos que existen actualmente.

Diagnosing borderline personality disorder during adolescence is usually controversial. In this paper we present a clinical case in which an outline of the main characteristics of borderline personality disorder during adolescence is summarised. The need of taking into consideration the precursor characteristics of borderline personality disorder in young people is also highlighted. At the same time, other significant behavioural disorders found in young people are emphasized as possible forerunners of a borderline personality disorder diagnosis. Finally, we insist upon the need to implement early intervention programmes for these patients based on current models.