Inflammatory Markers in Patients With Major Depressive Disorder: A Prospective, Clinic-Based, Cohort Study From India.

Background Patients with major depressive disorder have varying response rates to treatment. Multiple factors such as non-adherence, comorbidity, chronic stressors, and biological factors may be responsible for this variation. Inflammatory (pro and anti) markers have been well studied as a cause for depression, predisposing factors, and a consequence of depression. Among these, interleukins (ILs), interferons, C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) have been studied repeatedly. We conducted a pilot study to assess the levels of these inflammatory markers in patients with major depressive disorder. The specific objectives of this study were to compare and correlate changes in pro- and anti-inflammatory markers throughout different phases of depression, including pretreatment and posttreatment periods, and to evaluate the pattern of pro- and anti-inflammatory markers in patients who experienced remission or showed a positive response to treatment. Methodology This was a prospective, clinic-based, cohort study done for a period of one and a half years. Patients aged 18-65 years with depressive disorder per the International Classification of Diseases Tenth Edition and who scored more than 7 on the Hamilton Depression Rating Scale were included in this study. A total of 81 patients were recruited who were followed up till eight weeks after inclusion. A total of 31 patients completed the eight weeks of follow-up. Levels of IL-10 and TNF-α were assessed at baseline, two weeks, four weeks, and eight weeks of follow-up. Results This study tried to compare the levels of pro- and anti-inflammatory markers across pretreatment and various posttreatment phases of depression. Results showed that the levels of pro-inflammatory cytokine TNF-α increased from baseline till eight weeks of follow-up, and levels of IL-10 decreased from baseline till eight weeks of follow-up. However, these changes were not statistically significant. Conclusions This study supports the hypothesis that inflammatory markers can be trait markers of depression rather than the consequence or result.

Indian research on transcranial magnetic stimulation: A bibliometric analysis.

Background: A significant body of evidence on the role of TMS in neurology and psychiatry has emerged from Indian studies. Aims: We aimed to assess the existing and emerging trends of research on TMS as a diagnostic or therapeutic tool in India using bibliometric analysis. Results: A total of 146 publications, retrieved from various databases, were analyzed using Microsoft Excel and VOSviewer. We found a linear positive growth of publications in India in the field of TMS and neuropsychiatry, with about 3000 citations so far. The most researched diagnosis was schizophrenia. NIMHANS, Bengaluru, had the highest number of publications. The journal with the highest number of publications was the Asian Journal of Psychiatry, and that with the highest citations was the Journal of Affective disorders. Conclusion: The growth of Indian research in the field of TMS corresponds to that of the global one but also suggests the need for more studies to match the research output from other countries.

Study of Suicidal Behavior Among Admitted First-Episode Schizophrenia Patients From South India.

Objective: The range of suicidal behavior in first-episode schizophrenia in the early phases of the disease is both understudied and unclear. The objective of this study was to investigate suicidal behavior in first-episode schizophrenia inpatients after admission.Methods: The current study was conducted with 102 patients with first-episode schizophrenia aged 15 to 45 years who were admitted to a 300-bed psychiatry hospital in Southern India over a period of 18 months between January 1, 2016, and June 30, 2017. Patients completed a semistructured questionnaire, the Brief Psychiatric Rating Scale, and the Columbia-Suicide Severity Rating Scale for assessment of sociodemographic profile, psychopathology, and suicide risk. Patients were then divided into 2 groups: suicidal and nonsuicidal.Results: Recent suicidal ideation and behavior were present in 37.25% and 22.54% of the first-episode schizophrenia patients, respectively. Recent suicidal ideation was 15.8 times more likely in first-episode schizophrenia patients with lifetime suicidal ideation, and recent suicide attempts were 8.6 times more likely in patients with lifetime suicide attempts.Conclusions: The study results show that suicidal behavior in the early phases of first-episode schizophrenia is more prevalent during admission. Lifetime suicidal ideation and behavior predicts the risk of recent suicidal ideation and behavior, respectively.Prim Care Companion CNS Disord 2023;25(3):22m03364. Author affiliations are listed at the end of this article.

Evidence from Indian studies on safety and efficacy of therapeutic transcranial magnetic stimulation across neuropsychiatric disorders- A systematic review and meta-analysis.

Repetitive transcranial magnetic stimulation (rTMS) is potentially effective as an augmentation strategy in the treatment of many neuropsychiatric conditions. Several Indian studies have been conducted in this regard. We aimed to quantitatively synthesize evidence from Indian studies assessing efficacy and safety of rTMS across broad range of neuropsychiatric conditions. Fifty two studies- both randomized controlled and non-controlled studies were included for a series of random-effects meta-analyses. Pre-post intervention effects of rTMS efficacy were estimated in "active only" rTMS treatment arms/groups and "active vs sham" (sham-controlled) studies using pooled Standardized Mean Differences (SMDs). The outcomes were 'any depression', depression in unipolar/bipolar depressive disorder, depression in obsessive compulsive disorder (OCD), depression in schizophrenia, schizophrenia symptoms (positive, negative, total psychopathology, auditory hallucinations and cognitive deficits), obsessive compulsive symptoms of OCD, mania, craving/compulsion in substance use disorders (SUDs) and migraine (headache severity and frequency). Frequencies and odds ratios (OR) for adverse events were calculated. Methodological quality of included studies, publication bias and sensitivity assessment for each meta-analyses was conducted. Meta-analyses of "active only" studies suggested a significant effect of rTMS for all outcomes, with moderate to large effect sizes, at both end of treatment as well as at follow-up. However, except for migraine (headache severity and frequency) with large effect sizes at end of treatment only and craving in alcohol dependence where moderate effect size at follow-up only, rTMS was not found to be effective for any outcome in the series of "active vs sham" meta-analyses. Significant heterogeneity was seen. Serious adverse events were rare. Publication bias was common and the sham controlled positive results lost significance in sensitivity analysis. We conclude that rTMS is safe and shows positive results in 'only active' treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India. Conclusion: rTMS is safe and shows positive results in "only active" treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India.

Sexual Dysfunction and Satisfaction in Males With Alcohol Dependence: A Clinic-Based Study From Central India.

Background Apart from the alcohol effects on various domains of health, the effect on sexual health is the most concerning aspect to the individual. Chronic alcohol intake leads to sexual dysfunction leading to interpersonal difficulties which further worsens alcohol dependence creating a vicious cycle. Methodology This is a cross-sectional study done at an inpatient psychiatry ward of a tertiary care hospital after taking institutional ethical clearance and due informed consent from the participants. The study sample comprised of 50 alcohol dependent subjects and 50 healthy controls taken by purposive sampling based on the inclusion criteria. Subjects were rated on the Arizona sexual experiences (ASEX) scale for various aspects of sexuality and on the New sexual satisfaction scale (NSS) for the degree of sexual satisfaction. WHO-Quality of Life (WHOQOL)-BREF was used to assess the quality of life in both groups. Data was collected and analyzed using MS Excel and SPSS version 23 (IBM Corp., Armonk, USA),  Results The prevalence of sexual dysfunction in the study was about 40% with an inability to reach and satisfaction with orgasm (38% and 28% respectively) the most common followed by erectile dysfunction (26%). The patients with alcohol dependence had a significantly higher degree of sexual dysfunction, poor sexual satisfaction, and low quality of life compared to controls. With correlation analysis, the total scores on ASEX were positively correlated with the duration of alcohol use and dependence. Conclusions This study concludes that sexual dysfunction is common and seen in nearly half of the patients with alcohol dependence affecting desire, erection, and satisfaction with orgasm. Alcohol dependence further impairs the sexual satisfaction and quality of life of the individual. This information can be utilized in motivational interviewing of patients with alcohol dependence by addressing both the problems simultaneously to improve sexual functioning and quality of life.

Repetitive transcranial magnetic stimulation and its role in suicidality - A systematic review.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) as a brain stimulation modality is approved for the treatment of resistant depression and its efficacy in depression is also well supported in several studies. However, its effect on suicidality is still unclear, unlike electroconvulsive therapy. METHODOLOGY: This paper provides a systematic review of the literature published till June 2021. Studies that used rTMS as either monotherapy or adjunctive treatment in patients with suicidality, irrespective of their diagnosis, were included. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines was followed. A total of 20 studies (N = 1584) were included for the qualitative synthesis. The quality of studies was assessed using the Cochrane Risk of Bias tool for Randomised control trials (RCT) and the Newcastle-Ottawa Scale tool for Non-Randomised studies (NRS). RESULTS: Of the 20 articles selected for qualitative synthesis, 11 were RCTs and 9 were NRS. The results are categorized in domains of type of the study, size of population, type of population, diagnosis, assessment scales, mode of rTMS, stimulus parameters, safety and efficacy. CONCLUSIONS: The high frequency rTMS at left dorsolateral prefrontal cortex as an adjunct to antidepressant medication is promising in reducing suicidal behaviour in treatment resistant depression. However, role of TMS targeting other areas of stimulation in mitigating suicide risk in other disorders could not be established due to scarcity of such studies. The results should be interpreted cautiously as considerable risk of bias was present in the reviewed studies.

Fear, Psychological Impact, and Coping During the Initial Phase of COVID-19 Pandemic Among the General Population in India.

Introduction Public health emergencies such as pandemics affect the health, safety, and well-being of both individuals and societies. Thus, this study aims to better understand the fear due to coronavirus disease (COVID) and associated levels of anxiety, depression, stress, and coping in the general public of India during the initial stage of the COVID-19 outbreak. Materials and methods This was a cross-sectional study to assess the psychological impact of COVID-19 and coping levels among the general population during the coronavirus pandemic's initial phase. An online survey was conducted using a snowball sampling technique. Results A total of 489 people responded to the survey. The prevalence rates of depression, anxiety and stress were 27.2%, 21.5%, and 15.3% respectively. Female gender, age below 35 years, history of medical or psychiatric illness, and those who had personal contact with persons with COVID-19 were significantly associated with presence of depression, anxiety, and stress whereas spending more than 1 hour on COVID-19-related information was associated with significant stress. Conclusion This study concludes that the prevalence rates of psychological problems were high during the COVID-19 pandemic. These are directly related to the fear associated with COVID-19 but had an inverse relationship with the resilient coping levels.