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IMPORTANCE: Solid cancer patients following SARS-CoV-2 vaccination are likely to have a lower seroconversion rate than healthy adults. Seroconversion between those with and without cancer is likely to vary moderately or to be restricted to specific subgroups. Therefore, we sought to conduct a systematic review and meta-analysis to identify risk factors for diminished humoral immune responses in solid cancer patients. METHODS: MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were used to search literature through May 1, 2022. Prospective or retrospective studies comparing responders with non-responders against SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) following COVID-19 vaccination were included. Pooled Odds Ratios (pORs) with 95% CIs for binary variables and differences in means (with SDs) for continuous variables were calculated to determine the pooled effect estimates of risk factors for poor antibody response. RESULTS: Fifteen studies enrolling 3593 patients were included in the analysis. Seroconversion was seen in 84% of the pooled study population. Male gender, age >65 years, and recent chemotherapy were all factors in a poor immune response. Patients under follow-up, those who received immunotherapy or targeted therapy, were more likely to be seropositive. Cancer subtypes, vaccine types, and timing of antibody testing from the 2nd dose of vaccine did not correlate with seroconversion. CONCLUSION: Cytotoxic therapy for solid cancer may portend poor immune response following 2 doses of COVID-19 vaccines suggesting a need for booster doses in these patients. Immunotherapy and targeted therapy are likely to be associated with seropositive status, and thus can be considered as an alternative to cytotoxic agents in cases where both therapies are equally efficacious.
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COVID-19 , Neoplasms , Adult , Humans , Male , Aged , COVID-19 Vaccines/therapeutic use , Immunity, Humoral , Prospective Studies , Retrospective Studies , COVID-19/prevention & control , SARS-CoV-2 , Neoplasms/therapy , Antibodies, Viral , VaccinationABSTRACT
BACKGROUND: The COVID-19 pandemic has led to widespread controversies related to the transmission, treatment, prevention, and management of COVID-19 infection. Medical students have been involved in patient care across the globe and many a times the general public looks forward towards the medical professionals to get proper information about various issues related to COVID-19. We aimed to evaluate the knowledge and misconceptions held by the medical students on various aspects of COVID-19 infection. SUBJECTS AND METHODS: An online cross-sectional survey was conducted through the Survey Monkey® platform using the Whatsapp®, among the medical undergraduate students of a tertiary care Institute of Eastern India. RESULTS: 236 medical students (of different years of medical training/MBBS) participated in the survey and the response rate to the survey was 47.2%. The mean age of the participants was 20.91 (SD-1.86) years, and about three-fifths were males (58.5%). One-third students were either in their first year of MBBS (31.8%) or the final year (35.16%) of MBBS. Incorrect beliefs related to various preventive aspects, risk of increasing chance of getting infection and modes of spread of infection were present in a significant proportion of students, with a wide variation for specific issues. When the number of participants with at least one incorrect related to any of the aspects of COVID-19 infection was evaluated, it ranged from 59% to 85% in different domains. CONCLUSIONS: This survey highlights the widespread prevalence of misconceptions about various aspects of COVID-19 among medical students, which needs to be addressed by proper education and awareness.
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COVID-19 , Students, Medical , Male , Humans , Female , COVID-19/epidemiology , Cross-Sectional Studies , Pandemics , Health Knowledge, Attitudes, PracticeABSTRACT
Postpartum collapse is a life-threatening condition caused by obstetrical and non-obstetrical events. In this case report, we discuss a case of postpartum collapse in COVID-19-positive woman who required intensive care and mechanical ventilation for two days. After confusing collision of many provisional diagnoses soldiering for three days, she was ultimately diagnosed with malignant catatonia. Targeted therapy with lorazepam challenge resulted in drastic improvement, and she was discharged with her baby in healthy condition.
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India with a population of 1.3 billion has a unique health care system in its different states. Mental health care varies widely across the country and this became even more apparent after the COVID-19 pandemic set in. This paper examines the various strategies in response to COVID-19 adopted by the Government of India, the health departments of the individual states, and other private players such as on-government organizations and the civil society. The cessation of many services including outpatient and inpatient care and the scarcity of medicines were serious impacts of COVID-19. The prolonged lockdown in many parts of the country impeded access to mental health care services since public transport was unavailable. This led to many relapses in persons with serious mental disorders. The emergence of new cases of psychosis and an increase in suicides were also seen. Tele consultations came to the fore and many helplines were started offering counseling and guidance regarding the availability of mental health care facilities. While these helped the urban dwellers, those in remote and rural areas were unable to use these services effectively. Many mental health wards were used for COVID-19 patients and mental health professionals were deployed for COVID-19 related duty. The severely mentally ill, the homeless mentally ill, and the elderly were especially vulnerable. Based on our experience with COVID-19, we urge a strong call for action, in terms of strengthening the primary care facilities and increasing the manpower resources to deliver mental health care.
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Background: Many studies across the globe have evaluated the adverse mental health consequences of COVID-19 in patients who suffered from COVID-19 infection. However, a comparative study of persons who suffered from COVID-19 infection and those who witnessed the COVID-19 infection in their close relatives is lacking. Aims and Objectives: This study aims to compare the psychiatric morbidity in persons who suffered from COVID-19 infections, and those who witnessed the illness in one of their close relatives. Methods: In this cross-sectional online survey, 2,964 adult participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) Scale, Fear of COVID-19 Scale (FCS-19), Brief Resilient Coping Scale (BRCS), The Brief Resilience Scale (BRS) and a self-designed questionnaire to evaluate other neuropsychiatric complications. Results: Compared to the close relatives who had witnessed COVID-19 infection, participants who developed COVID-19 infection had a significantly higher prevalence of depression (34.6%), anxiety disorder (32.3%), and fear of COVID-19 infection (18.8%), which was significantly higher than that noted in close relatives. However, BRS coping score was not significantly different between the two groups. Overall, about one-third of the participants who developed COVID-19 infection had depression and one-third had anxiety disorders. One-fifth of the participants reported high fear, post-traumatic symptoms, and obsessive-compulsive symptoms, whereas one-sixth reported other neuropsychiatric manifestations. Conclusion: Patients who suffered from COVID-19 have a higher prevalence of depression, anxiety, and fear as compared to those to witnessed COVID-19 in relatives.
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Background The literature on presence of cognitive deficits in patients recovered from coronavirus disease 2019 (COVID-19) infection is emerging. However, the data on whether cognitive deficits have its onset during the acute phase of illness has not been evaluated extensively. Aim This article estimates the level of cognitive functioning of patients with COVID-19 while they were admitted to COVID-designated wards. Secondary objectives were to assess the influence of medical comorbidities, severity of COVID-19 infection, and depressive and anxiety symptoms on cognitive functioning in patients with COVID-19 infection. Methods Sixty-six clinically stable patients with COVID-19 infection were evaluated during their inpatient stay on Hindi Montreal Cognitive Assessment scale (H-MoCA), Hindi Mini-Mental State Examination (HMSE) scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Questionnaire -7. Results The mean age of the study participants was 39.85 (standard deviation [SD] 16.89) years and the participants were evaluated after 9.34 (SD 4.98;median 9.0) days of being diagnosed with COVID-19 infection. About one-fourth (28.8%;n = 19) of the participants had cognitive impairment on HMSE and about two-fifths ( n = 26;39.39%) had cognitive impairment as per the cutoff used for H-MoCA. A higher level of cognitive deficits were seen among participants who were older, diagnosed with diabetes mellitus, and those who required oxygen support during their hospital stay prior to assessment. Conclusion Low cognitive score was found in one-fourth (28.8%) to two-fifths (39.9%) of the persons, depending on the assessment scale among those with acute COVID-19 infection. Low cognitive score was more prevalent among the elderly, those with diabetes mellitus, and those who required oxygen support prior to the assessment.
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Background: Few studies across the globe have evaluated the adverse mental health consequences of COVID-19, in patients who suffered from COVID-19 infection. However, a comparative study of persons who suffered from COVID-19 and those who witnessed the COVID-19 infection in their 1 st degree relative/s is lacking. Aims & Objectives: This study aims to compare the psychiatric morbidity in persons who suffered from COVID-19 infections, and those who witnessed the illness in one of their first degree relative/s. Methods: In this cross-sectional online survey, 2964 adult participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Fear of COVID-19 Scale (FCS-19), Brief Resilient Coping Scale (BRCS), The Brief Resilience Scale (BRS) and a self-designed questionnaire to evaluate Neuropsychiatric issues. Results- Mean PHQ-9, GAD-7 and FCS-19 were significantly higher in those who themselves suffered from COVID-19 as compared to those who witnessed the infection in their 1 st degree relative (7.41 ± 7.09 vs 6.56 ± 6.15;p<0.0001;5.58 ± 6.59 vs 5.10 ± 5.97;p=0.001;11.32±6.45 vs 10.48±6.12;p=0.001 respectively). However, BRS coping score was not significantly different between both the groups. Overall, about 1/3 rd of the participants who developed COVID-19 infection had depression and one-third had anxiety disorders. One-fifth of the participants reported high fear, PTSD and OCD symptoms, while 1/6 th reported other neuropsychiatric manifestations. Conclusion: Patients who suffered from COVID-19 had higher prevalence of PHQ-9, GAD-7 and FCS-19 as compared to those to witnessed COVID-19 in relatives but with similar BRCS.
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Background: The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. Aim: To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre and how patients with suicidal behaviour were handled during the initial consultation. Methods: All new adult patients (aged >18 years) registered with telepsychiatry services during 19th July to 20th of Sept 2021 were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). Results: The study included 1065 adult patients (aged≥18 years). In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% ofthe patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in thelast few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of non-suicidal self-injurious behaviour (NSSI) in the lifetime and0.5% had NSSI behaviour in the last few weeks. Based on the suicidality, 1% of thepatients were asked to report to the emergency immediately, 1.4% were given an appointment within 72 hours for follow-up and 3.6% were explained high risk management. Conclusions: Suicidal behaviour, especially active suicidal ideations and suicidal plan is not very prevalent in patients seeking telepsychiatry consultation.
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Background: During the Covid-19 pandemic, telepsychiatry has become normalised in multiple institutes across India as the primary method of care delivery. However, not much evidence is available regarding the experience of a tele-psychiatry consultation for both the care-providing clinician as well as the recipient. Objective: This study aims to assess the experience and satisfaction of the clinician and the patients/their caregiver during a telepsychiatry consultation. Methods: Clinicians scored their experience of providing the consultation to patients over a call(video/audio) in a detailed Google form based questionnaire on a 6 point Likert scale, ranging from very dissatisfied to very satisfied. Patient’s sociodemographic details were collected in a standard manner. Patients were sent a modified version of the Google form questionnaire on their registered mobile number to report their degree of satisfaction, after the call ended. Results: 371 consecutive teleconsultations between April to June 2021 were assessed by 3 clinicians, of which 132 patients/caregivers responded back. The patients had a mean age of 43.5 years, were mostly male, married, educated beyond matric, employed and belonged to urban nuclear families. The average distance of their location from the hospital was 178 km and more than 80% of the patients were accompanied by their relatives in the teleconsultation. 53.6% of the consultations did not face any technological problems, while 24% had connectivity issues from the patient side. Overall, ~66.8% clinicians and 62% of the patients reported being satisfied to a large extent. 66% of the clinicians felt teleconsultation experience was same as an in-person consultation. Conclusions: Teleconsultation in psychiatric patients might not be as difficult as intuitively thought and needs to be explored further as an opportunity to reach out to a larger population, beyond the urban educated sociodemographic group who are the primary beneficiaries in the current scenario.
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Pneumonia, an acute respiratory tract infection, is one of the major causes of mortality worldwide. Depending on the site of acquisition, pneumonia can be community acquired pneumonia (CAP) or nosocomial pneumonia (NP). The risk of pneumonia, is partially driven by host genetics. CYP1A1 is a widely studied pulmonary CYP family gene primarily expressed in peripheral airway epithelium. The CYP1A1 genetic variants, included in this study, alter the gene activity and are known to contribute in lung inflammation, which may cause pneumonia pathogenesis. In this study, we performed a meta-analysis to establish the possible contribution of CYP1A1 gene, and its three variants (rs2606345, rs1048943 and rs4646903) towards the genetic etiology of pneumonia risk. Using PRISMA guidelines, we systematically reviewed and meta-analysed case-control studies, evaluating risk of pneumonia in patients carrying the risk alleles of CYP1A1 variants. Heterogeneity across the studies was evaluated using I2 statistics. Based on heterogeneity, a random-effect (using maximum likelihood) or fixed-effect (using inverse variance) model was applied to estimate the effect size. Pooled odds ratio (OR) was calculated to estimate the overall effect of the risk allele association with pneumonia susceptibility. Egger's regression test and funnel plot were used to assess publication bias. Subgroup analysis was performed based on pneumonia type (CAP and NP), population, as well as age group. A total of ten articles were identified as eligible studies, which included 3049 cases and 2249 healthy controls. The meta-analysis findings revealed CYP1A1 variants, rs2606345 [T vs G; OR = 1.12 (0.75-1.50); p = 0.02; I2 = 84.89%], and rs1048943 [G vs T; OR = 1.19 (0.76-1.61); p = 0.02; I2 = 0.00%] as risk markers whereas rs4646903 showed no statistical significance for susceptibility to pneumonia. On subgroup analysis, both the genetic variants showed significant association with CAP but not with NP. We additionally performed a spatial analysis to identify the key factors possibly explaining the variability across countries in the prevalence of the coronavirus disease 2019 (COVID-19), a viral pneumonia. We observed a significant association between the risk allele of rs2606345 and rs1048943, with a higher COVID-19 prevalence worldwide, providing us important links in understanding the variability in COVID-19 prevalence.
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COVID-19 , Community-Acquired Infections , Pneumonia , COVID-19/genetics , Cues , Cytochrome P-450 CYP1A1/genetics , Genetic Predisposition to Disease , Human Genetics , Humans , Pneumonia/genetics , Polymorphism, Single Nucleotide , Risk FactorsABSTRACT
BACKGROUND: The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. AIM: To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre. METHODS: 1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). RESULTS: In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management. CONCLUSIONS: Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.
Subject(s)
Mental Disorders , Mental Health Services , Suicidal Ideation , Telemedicine , Adult , COVID-19/epidemiology , Humans , Mental Disorders/therapy , Mental Health Services/organization & administration , Pandemics , Telemedicine/organization & administration , Tertiary Care CentersABSTRACT
Introduction:The literature related to quarantined nurses? lived experiences working in nondesignated COVID settings is scarce. This study aimed to explore the lived experiences of quarantined nurses after accidental exposure in nondesignated COVID areas in a tertiary care hospital.Material and Methods:It was a qualitative phenomenological study. Snowball sampling technique was used to interview 11 nurses. The in-depth interviews were conducted telephonically using a prevalidated interview guide during October 2020 to February 2021. The interviews were audiotaped, transcribed, and translated to English. Thematic analysis was done using Colaizzi?s phenomenological method. The findings depicting similar codes were grouped into subthemes and themes. The findings are presented thematically with corresponding participant quotes.Results:Out of 11, six (55%) participants were quarantined in home and five (45%) in the institutional facilities. The major themes that emerged were: ?psychological reactions,? ?quarantine: the positive aspect,? and ?support system? among the home quarantined nurses. The major themes in the institutional facility quarantined nurses were: ?psychological reactions,? ?poor quality of institutional quarantine facility,? ?quarantine: the positive aspect,? ?support system,? and ?quarantine: a learning experience.? The nurses experienced various negative emotions during quarantine.Conclusion:To safeguard the physical and mental health of nurses, comprehensive support should be provided by the authorities in terms of availability of basic amenities and quality services during quarantine. Regular training and constant motivation are needed to promote their mental preparedness for crisis management.
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Context: Telepsychiatry is being practiced in India for many years but was formalized only in 2020. It has many advantages and disadvantages. Aims: This study aimed to understand the perceived advantages and disadvantages of telepsychiatry practices in India. Settings and Design: An online survey with ethics approval by the Indian Psychiatric Society (IPS) Ethics Review Board. All psychiatrists who are members of the IPS and whose email address was available with the society were sent the survey link by email. Methodology: Information about existing telepsychiatry consultation practices in India and perception of advantages and disadvantages by the practitioners were collected between June and July 2020. Statistical Analysis: Frequency, percentages, mean, and standard deviation were calculated. Results: Responses by 340 responders were analyzed. Majority of the responders felt that telepsychiatry would provide easy accessibility to mental health services (n = 283, 83.24%) and would lead to less exposure to infections (n = 222, 65.29%). Half of the responders (n = 177, 52.06%) felt that there would be an increased doctor shopping resulting in poor care and nearly three-fourth (n = 245, 72.06%) felt that mental health professionals would fall into a problem while dealing with a suicidal or a homicidal patient. Some expressed that the inability to do physical and central nervous system examinations could lead to missing out comorbidities. About one-third (n = 117, 36.56%) felt that the patient recording the consultation would be a legal issue. Conclusions: This online survey showed that psychiatrists perceive many advantages and some disadvantages in practicing telepsychiatry.
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Background The literature on presence of cognitive deficits in patients recovered from coronavirus disease 2019 (COVID-19) infection is emerging. However, the data on whether cognitive deficits have its onset during the acute phase of illness has not been evaluated extensively. Aim This article estimates the level of cognitive functioning of patients with COVID-19 while they were admitted to COVID-designated wards. Secondary objectives were to assess the influence of medical comorbidities, severity of COVID-19 infection, and depressive and anxiety symptoms on cognitive functioning in patients with COVID-19 infection. Methods Sixty-six clinically stable patients with COVID-19 infection were evaluated during their inpatient stay on Hindi Montreal Cognitive Assessment scale (H-MoCA), Hindi Mini-Mental State Examination (HMSE) scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Questionnaire -7. Results The mean age of the study participants was 39.85 (standard deviation [SD] 16.89) years and the participants were evaluated after 9.34 (SD 4.98; median 9.0) days of being diagnosed with COVID-19 infection. About one-fourth (28.8%; n = 19) of the participants had cognitive impairment on HMSE and about two-fifths ( n = 26; 39.39%) had cognitive impairment as per the cutoff used for H-MoCA. A higher level of cognitive deficits were seen among participants who were older, diagnosed with diabetes mellitus, and those who required oxygen support during their hospital stay prior to assessment. Conclusion Low cognitive score was found in one-fourth (28.8%) to two-fifths (39.9%) of the persons, depending on the assessment scale among those with acute COVID-19 infection. Low cognitive score was more prevalent among the elderly, those with diabetes mellitus, and those who required oxygen support prior to the assessment.
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Aim:This study aimed to assess the characteristics and trends of research on substance use and COVID-19.Methods:Keywords related to ?Covid-19? and ?Substance Use? were used in a search query formulated for the Scopus search engine. The articles published during the years 2020 and 2021, through early November 2021, were considered.Results:A total of 2184 publications were published on this topic, averaging 9.69 citations per paper. About one-seventh (13.96%) share of global publications was supported by extramural funding support. The maximum number of publications emerged from the United States of America (USA) (n = 831;38.05%), followed by the United Kingdom (UK) (n = 212;9.71%), India (n = 165;7.55%), and Canada (155 papers;7.10%). In terms of citation impact, publications emerging from China (24.42 and 2.52) had the highest citation impact, followed by publications emerging from Australia (18.83 and 1.94), France (16.48 and 1.70), the UK (15.44 and 1.59), Italy (13.36 and 1.38), and Canada (12.73 and 1.31). When the data in terms of specific institutes were evaluated, Harvard Medical School, USA (n = 52), was ranked first in productivity, followed by the University of Toronto, Canada (n = 47);the Yale School of Medicine, USA (n = 35);INSERM, France (n = ?29);and the University of British Columbia, Canada (n = 2s). The University College London, UK (30.24 and 3.12), ranked first in citation impact, followed by INSERM, France (22.0 and 2.27);the Sapienza University of Rome, Italy (17.4 and 1.8);and the University of Toronto, Canada (13.68 and 1.41). When the journals were evaluated, the International Journal of Environmental Research and Public Health (n = 83) ranked first in publication productivity, followed by the Journal of Substance Abuse Treatment (n = 73), Frontiers in Psychology (n = 39), Drug and Alcohol Dependence (n = 28), and International Journal of Drug Policy (n = 26).Conclusion:This bibliometric study suggests that a large amount of literature has accumulated during the COVID-19 pandemic on substance use disorders, both from developed and developing countries.
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Objectives: The present study examines the publication output of authors from India on the topic of "Covid-19 and Psychology" using bibliometric methods. Methods: The publications as listed in Scopus database were identified by using "Covid-19" and its synonyms keywords in "Keyword" and "Title" tags. The results obtained were further restricted to subject "Psychology" under subject tag and country to India. Results: 372 publications emerged in the last 2 years on the topic of "Covid-19 and Psychology", accounting to 4.63% share of global output. About 9.95% and 25.81% share of Indian publications received external funding support and involved international collaboration, respectively. The author's from 277 organizations and 416 authors participated unevenly in the research in this area. The highest number of publications emerged from National Institute of Mental Health and Allied Sciences (NIMHANS), Bangaluru, followed by Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, All India Institute of Medical Sciences (AIIMS), New Delhi and All India Institute of Medical Sciences (AIIMS), Bhubaneswar. Authors from Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry had highest impact in terms of citations per paper and relative citation index, followed by authors from King George's Medical University (KGMU), Lucknow, and Manipal Academy of Higher Education (MAHE), Manipal. The journals that published the highest number of publications were Asian Journal of Psychiatry (158 papers), Indian Journal of Psychological Medicine (44 papers), and Frontier in Psychology (18 papers). The most commonly investigated topics in terms of frequency of appearances of keywords were mental health (93), followed by anxiety (80), mental disease (68), depression (64), mental stress (34), and social isolation. Conclusion: Over the last 2 years a large number of publications have emerged in the area of COVID-19 and psychology from India. [ FROM AUTHOR] Copyright of International Journal of Medicine & Public Health is the property of SCIBIOLMED.ORG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)