Gestational exposure to benzodiazepines or z-hypnotics and neurodevelopmental disorders in offspring: Systematic review and meta-analysis.

INTRODUCTION: Benzodiazepine (BDZP) and/or z-hypnotic dispensing during pregnancy has increased globally, as have rates of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aimed to estimate the association between gestational exposure to BDZP and/or z-hypnotics and diagnosis of ASD or ADHD in offspring. METHODS: We searched MEDLINE, EMBASE, and SCOPUS from inception till December 2023 for relevant English-language articles. Outcomes of interest were risk of ASD and ADHD, two independent primary outcomes, in children exposed anytime during pregnancy to BDZP and/or z-hypnotics versus those unexposed. Secondary outcomes were trimester-wise analyses. Using a random effects model, we pooled the overall and trimester-wise hazard ratios (HRs), with 95% confidence intervals (CIs), separately for risk of ASD and ADHD. RESULTS: We found six eligible retrospective cohort studies and no case-control studies. There was no increased risk of ASD associated with anytime gestational BDZP and/or z-hypnotic exposure (primary outcome, HR, 1.10; 95% CI, 0.81-1.50; 4 studies; n = 3,783,417; 80,270 exposed, 3,703,147 unexposed) nor after first trimester exposure (HR, 1.15; 95% CI, 0.83-1.58; 3 studies; n = 1,539,335; 70,737 exposed, 1,468,598 unexposed) or later trimester exposures. A very small but significantly increased risk of ADHD was noted with anytime gestational exposure to these drugs (primary outcome, HR, 1.07; 95% CI, 1.03-1.12; 4 studies; n = 2,000,777; 78,912 exposed, 1,921,865 unexposed) and also with (only) second trimester exposure (HR, 1.07; 95% CI, 1.03-1.12; 3 studies; n = 1,539,281; 33,355 exposed, 1,505,926 unexposed). Findings were consistent in sensitivity analyses. CONCLUSION: Gestational exposure to benzodiazepines or z-hypnotics was not associated with an increased risk of ASD and with only a marginally increased risk of ADHD in offspring. Given the likelihood of confounding by indication and by unmeasured variables in the original studies, our findings should reassure women who need these medications for severe anxiety or insomnia during pregnancy.

Efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in focal hand dystonia: Systematic review of intervention trials.

We reviewed trials examining the efficacy of repetitive transcranial magnetic stimulation (rTMS) (seven trials) and transcranial direct current stimulation (tDCS) (seven trials) in focal and dystonia (FHD). Among tDCS trials, one randomized controlled trial and three quasi-experimental studies showed evidence of efficacy; these trials combined different types of stimulations or used tDCS along with neurorehabilitation. Four rTMS trials showed evidence of efficacy but differed in stimulation parameters. Risk of bias was noted in nearly all the trials. There is weak and inconsistent evidence for the efficacy of rTMS and tDCS administered alone or with other interventions in FHD.

Suicide reporting of LGBTQI+ population in India: An analysis of online media reports of the past decade.

BACKGROUND: Imbalanced portrayal of suicide by the media can have adverse public health consequences. We aimed to evaluate the psychosocial context, as well as the quality of media reporting, of suicide among lesbian, gay, bisexual, transgender people, queer and intersex (LGBTQI+) population. METHODS: A cross-sectional study was conducted to evaluate online news reports discussing the suicide of LGBTQI+ persons published between January 2011 and January 2021. Psychosocial factors associated with suicide were extracted from the reports. Quality of suicide reporting was checked against international as well as locally relevant reporting guidelines. RESULTS: A total of 135 suicide reports from five newspapers were analyzed. Multiple psychosocial stressors were reported in 54.5% of the suicides. Social stigma was the most common factor associated with LGBTQI+ suicide. Several breaches of reporting were noted in relation to mentioning the identity (55.6%) and method of suicide (54.3%) in the title of report and inclusion of the deceased's photograph (20.4%). Potentially helpful reporting characteristics, such as including educational information (2.2%), mentioning warning signs (12.6%) and suicide support service details (3.7%), were rarely practiced. Local language news articles displayed more frequent and serious violations compared to English news reports. CONCLUSION: Indian media reporting of suicide among LGBTQI+ persons is poorly adherent to reporting guidelines.

Trends in female authorship in two major psychiatry journals in India.

Women authors are under-represented in academic medicine and academic publishing. We examined the representation of women in key authorship positions in psychiatric journals in India as well as time trends in female authorship across a decade. All articles originating from India and published in two leading Indian psychiatry journals during 2019-2020 were examined and compared with articles published in these journals during 2009-2010. Important outcomes examined were representations of women as first author, corresponding author, and last author, and the number of women in authorship lists. A total of 817 articles was analyzed; of these, 251 (30.7%) were published during 2009-2010 and 566 (69.3%) during 2019-2020. Women first-authored just over a quarter of the articles (n = 218, 26.7%). Nearly half of the articles (n = 389, 47.6%) had no woman author. Representation of women in key authorship positions and in total authorship increased significantly across time. Notably, the proportion of women first authors significantly increased for original papers (24.5% in 2009-2010 vs 38.1% in 2019-2020, p = 0.011). Gender gap in academic psychiatry publishing in India has narrowed during the past decade but is still evident. There is a need to identify and address factors that could narrow the gender gap.

Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach.

Background Psychiatric disorders are more common among people undergoing cosmetic procedures than the general population and evaluating mental health can be cumbersome for plastic surgeons. We aim to summarize the available literature in this regard and propose an integrated approach to psychiatric assessment and management of mental health issues among this group. Methods Electronic search of MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles from inception till April 2020. Generated abstracts were screened for their eligibility. Included articles were grouped according to their thematic focus under the following headings; prevalence of psychiatric morbidity among clients posted for cosmetic surgery, assessment tools, and management of psychiatric morbidity in relation to undergoing cosmetic surgery. Results A total of 120 articles were reviewed. The prevalence of psychiatric disorder in patients undergoing cosmetic surgery was 4 to 57% for body dysmorphic disorder (BDD); the corresponding figures for depression, anxiety, and personality disorder were 4.8 to 25.8, 10.8 to 22, and 0 to 53%, respectively. A range of tools have been used to assess these disorders and specific measures are also available to assess clinical outcomes following surgery. Screening for these disorders is essential to prevent unnecessary surgical procedures, as well as to ensure timely management of the psychiatric comorbidity. Conclusion Psychiatric morbidity is a common concomitant in cosmetic surgery. A structured and integrated approach to evaluation and management of psychiatric morbidity will help to optimize postsurgical outcomes.

Variations in newspaper reporting of suicidal behavior in the WHO-South-East Asian region.

BACKGROUND: South-East Asia is a densely populated region, comprising of 11 low- and middle-income countries and contributing to 39% of global suicides. There are serious challenges to suicide prevention in the region such as lack of high-quality suicide data, underreporting and poor quality of media reporting. The current report aimed to assess the variations in newspaper reporting of suicidal behavior in the World Health Organization-South-East Asian countries. METHODS: We analyzed the contents of nine research articles on media reporting of suicide, published from four South-East Asian countries (four from Bangladesh, three from India, one each from Indonesia and Bhutan) that used similar methods and presented results in a nearly similar fashion. RESULTS: Personal identifying information of the deceased was very frequently mentioned in the newspaper reports across the countries. Suicide notes were reported more commonly in India (9.5-18%) than Bangladesh (4.2-7.5%) and Indonesia (9.5%). No educative material was found in any of the newspaper reports of Bangladesh and Indonesia while it was rarely reported in Bhutan and India. CONCLUSION: Our findings from the four South-East Asian countries suggest that there are variations between the countries while presenting the news reports of suicidal behavior. These findings would help to formulate and regulate the media guidelines for the specific country.

Psychological autopsy: Overview of Indian evidence, best practice elements, and a semi-structured interview guide.

BACKGROUND: No review has been attempted, so far, on Indian psychological autopsy (PA) literature. There is also a dearth of interview guides which is at the heart of a PA procedure. MATERIALS AND METHODS: Electronic searches of MEDLINE through PubMed, PsycINFO, and Google scholar databases were carried out from inception till February 2020 to identify relevant English language peer-reviewed articles from India, as well as global literature that provided information on best practice elements in PA. Abstracts generated were systematically screened for eligibility. Relevant data were extracted using a predesigned structured proforma, and a semi-structured interview guide was developed. RESULTS: A total of 18 original articles, one case report, and three reviews/expert opinion articles which tried to give a description of PA procedure were found from India. Most Indian studies are of suicide PA (SPA), done to assess risk factors associated with suicide. There was a wide variation in reported rates of psychiatric morbidity among suicide decedents, while the other major risk factor for suicide in the Indian setting was stressful life events. An optimal approach to PA involves systematically collecting information from key informants and other sources using a narrative interviewing method, supplemented with psychological measures, and is probably best carried out within 1-6 months after the death. CONCLUSION: There have been limited attempts to standardize PA. Most Indian studies use SPA. We propose a semi-structured PA interview guide, suitable for both research and investigational purposes.