Maternal mental health and its determinants during COVID-19, experience from Kashmir, Northern India.

Background: Since the start of the pandemic due to coronavirus 2019, stresses and anxiety have increased in all age-groups. We aimed to study the common mental disorders in pregnant and lactating females and study their fears and copings during the pandemic. Materials and Methods: Purposive sampling was employed in our study. We included all pregnant and lactating females who consented to participate in the study. A total of 95 females were included in our study. We used a semi-structured questionnaire with questions regarding socio-demographic variables and questions related to apprehensions due to COVID-19, belonging to high-risk group, and structured instruments like Edinburgh Postnatal Depression Scale, Hamilton Anxiety Rating Scale, Yale-Brown Obsessive Compulsive Scale. Results: The mean age of our study population was 30.8 ± 3.67 years. The majority of our patients were married (93) and homemakers (61) and studied up to 12th grade. Among our patients, 33 tested positive for COVID-19 and 12 patients were hospitalized for COVID-19-related symptoms. Thirty-nine females were pregnant and 56 were lactating. Preexisting medical illness was seen in 23, and psychiatric illness was already present in 19 patients. Major depression was seen in 43% of females, mild anxiety symptoms in 69%, severe anxiety in 8%, mild obsessive compulsive disorder in 16%, and moderate in 10% of cases. Conclusion: In our cases, anxiety and depression were seen in increased prevalence as compared to pre-pandemic levels. Being hospitalized for COVID-19 symptoms, social isolation and apprehensions regarding the baby increased the risk of depression.

Pattern of dermatoses in two groups of admitted psychiatric patients: a cross-sectional study from a tertiary care hospital in Kashmir.

BACKGROUND: Various specific and non-specific dermatological manifestations can be found in patients with psychiatric ailments. Most studies in this regard have been conducted on an outpatient basis and not much work has been done on patients admitted with psychiatric diseases. METHODS: This cross-sectional hospital-based study involved two groups of admitted psychiatric patients over a period of 1 year, involving 100 patients in each group. In the family ward group patients were admitted with accompanying family members, whereas in the closed ward group patients were kept under custodial care. RESULTS: In the family ward setting, eczema was the most common finding, observed in 29 patients, followed by atrophic scarring in 28 patients, erythema ab igne in 25 patients, and bacterial infections in five patients. Various forms of nail changes were seen in 18 patients. In the closed ward group, most common dermatological involvement was parasitic infestation, seen in 56 patients, followed by generalized pruritus in 53 patients and atrophic scarring in 52 patients. Thirty-eight patients had nail changes. CONCLUSION: Skin manifestations are more common in chronic neglected psychiatric patients under custodial care. The authors stress upon the importance of familial care provided to psychiatric patients living in custodial settings.

Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module.

BACKGROUND & OBJECTIVES: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. METHODS: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. RESULTS: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. INTERPRETATION & CONCLUSIONS: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India.

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50-90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. METHODS: This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. RESULTS: Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). CONCLUSIONS: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Association between serotonin transporter gene promoter-region polymorphism and 4- and 12-week treatment response to sertraline in posttraumatic stress disorder.

BACKGROUND: We examined the association between serotonin transporter (5HTTLPR) genotype (SS vs SL vs LL) and sertraline treatment outcome in posttraumatic stress disorder (PTSD). METHODS: Outpatients (n=330) with PTSD underwent 5HTTLPR genotyping. All patients received sertraline (100 mg/day) for 12 weeks. Patients were assessed using the Clinician-Administered PTSD Scale (CAPS) and other instruments. Patients and rater were blind to the genotyping results. The primary outcome was completer sample CAPS improvement at 12 weeks. Response was defined as ≥30% improvement in CAPS total score with a CGI-I score of 1 or 2. RESULTS: The discontinuation rate was 31.5%. Adverse events led to drop out in 18.1%, 15.3%, and 5.9% of SS, SL, and LL patients, respectively (P=0.038). Among completers, there were 95, 43, and 88 patients with the SS, SL, and LL genotypes, respectively. At endpoint, CAPS total scores improved by 26% vs 46%, respectively, in SS and SL vs LL patients (P<0.001); much of this improvement (15% vs 31% in SS and SL vs LL patients, respectively; P<0.001) was apparent by week 4. The findings were largely similar for the other outcome measures. The response rate was 0%, 0%, and 47.7% in the SS, SL, and LL groups, respectively (P<0.001). LIMITATIONS: We administered a fixed dose of sertraline. For sociopolitical reasons, we planned a completer analysis only. CONCLUSIONS: Relative to the SS and SL 5HTTLPR genotypes, the LL genotype is associated with greater responsiveness of PTSD to sertraline (100mg/day) and with lower drop out due to adverse events. The S allele is associated with a striking specificity for treatment nonresponse, as defined in this study.

Serotonin transporter gene polymorphism and psychiatric disorders: is there a link?

Though still in infancy, the field of psychiatric genetics holds great potential to contribute to the development of new diagnostic and therapeutic options to treat these disorders. Among a large number of existing neurotransmitter systems, the serotonin system dysfunction has been implicated in many psychiatric disorders and therapeutic efficacy of many drugs is also thought to be based on modulation of serotonin. Serotonin transporter gene polymorphism is one of the most extensively studied polymorphisms in psychiatric behavioral genetics. In this article, we review the status of evidence for association between the serotonin gene polymorphism and some common mental disorders like affective disorders, post-traumatic stress disorder, obsessive-compulsive disorder, suicide, autism, and other anxiety and personality disorders. Going beyond traditional association studies, gene-environment interaction, currently gaining momentum, is also discussed in the review. While the existing information of psychiatric genetics is inadequate for putting into practice genetic testing in the diagnostic work-up of the psychiatric patient, if consistent in future research attempts, such results can be of great help to improve the clinical care of a vast majority of patients suffering from such disorders.

Efficacy of ECT in chronic, severe, antidepressant- and CBT-refractory PTSD: an open, prospective study.

BACKGROUND: Treatment options are limited in patients with severe, chronic, posttraumatic stress disorder (PTSD). There is little information on the use of electroconvulsive therapy (ECT) for PTSD. METHODS: Between January 1, 2005, and December 31, 2005, all consenting adults (n=20) with severe, chronic, extensively antidepressant-refractory PTSD were prospectively treated with a fixed course of 6 bilateral ECT treatments administered on an outpatient basis at a twice-weekly frequency. The primary outcome measure was improvement on the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS). Baseline refractoriness was defined as a failure to respond to an adequate course of at least 4 different antidepressant drugs along with 12 sessions of cognitive behavior therapy. Response to ECT was defined as at least 30% attenuation of CAPS ratings, and remission as an endpoint CAPS score of 20 or less. After ECT, patients were prescribed sertraline (100-150 mg/day) or mirtazapine (15-30 mg/day). RESULTS: All but 3 patients completed the ECT course. An intent-to-treat analysis (n=20) showed statistically and clinically significant improvement in the sample as a whole: CAPS scores decreased by a mean of 34.4%, and depression scores by a mean of 51.1%. Most of the improvement in CAPS and depression ratings developed by the third ECT; that is, by day 10 of treatment, itself. The improvement in CAPS ratings was independent of the improvement in depression ratings; and improvement in CAPS did not differ significantly between patients with less severe vs more severe baseline depression. The response rate was 70%; no patient remitted. In the completer analysis (n=17), mean improvements were 40% and 57% for CAPS and depression ratings, respectively, and the response rate was 82%. Treatment gains were maintained at a 4-6 month follow-up. CONCLUSIONS: ECT may improve the core symptoms of PTSD independently of improvement in depression, and may therefore be a useful treatment option for patients with severe, chronic, medication- and CBT-refractory PTSD.

Serotonin transporter gene polymorphism and treatment response to serotonin reuptake inhibitor (escitalopram) in depression: An open pilot study.

BACKGROUND: Blocking of the serotonin transporter is the main mechanism of action of SSRIs; therefore, the gene encoding this protein is a strong candidate for a possible genetic influence on the treatment response. AIM: To evaluate relationship between serotonin transporter gene promoter region polymorphism and the efficacy of SSRI (escitalopram) treatment in depression. MATERIALS AND METHODS: Fifty-seven consecutive patients with unipolar depressive episode (DSM IV criteria) were genotyped for the SERT gene polymorphism and treated with escitalopram 20 mg/day. Weekly assessment (HAM-D-21) was made for treatment response up to 6 weeks. RESULTS: Significant (P > 0.0001) difference between groups (ll vs. ss or ls) in response to treatment by escitalopram was revealed by our study. However, no difference with respect to age, gender, or onset of illness was observed between genotype subgroups. CONCLUSION: The study suggests that serotonin transporter gene polymorphism may have an influence on the effectiveness of SSRI treatment in depressive disorders, irrespective of clinical variables. Further controlled studies are required to validate these results.

A study on p53 gene alterations in esophageal squamous cell carcinoma and their correlation to common dietary risk factors among population of the Kashmir valley.

AIM: To systematically examine the extent of correlation of risk factors, such as age, consumed dietary habit and familial predisposition with somatic Tp53 molecular lesion causal to elevate carcinogenesis severity of esophageal squamous cell carcinoma (ESCC) among the Kashmiri population of Northern India. METHODS: All cases (n = 51) and controls (n = 150) were permanent residents of the Kashmir valley. Genetic alterations were determined in exons 5-8 of Tp53 tumor suppressor gene among 45 ESCC cases histologically confirmed by PCR-SSCP analysis. Data for individual cancer cases (n = 45) and inpatient controls (n = 150) with non-cancer disease included information on family history of cancer, thirty prevailing common dietary risk factors along with patient's age group. Correlation of genetic lesion in p53 exons to animistic data from these parameters was generated by Chi-square test to all 45 histologically confirmed ESCC cases along with healthy controls. RESULTS: Thirty-five of 45 (77.8%) histologically characterized tumor samples had analogous somatic mutation as opposed to 1 of 45 normal sample obtained from adjacent region from the same patient showed germline mutation. The SSCP analysis demonstrated that most common p53 gene alterations were found in exon 6 (77.7%), that did not correlate with the age of the individual and clinicopathological parameters but showed significant concordance (P<0.05) with familial history of cancer (CD = 58), suggesting germline predisposition at an unknown locus, and dietary habit of consuming locally grown Brassica vegetable "Hakh" (CD = 19.5), red chillies (CD = 20.2), hot salty soda tea (CD = 2.37) and local baked bread (CD = 1.1). CONCLUSION: Our study suggests that somatic chromosomal mutations, especially in exon 6 of Tp53 gene, among esophageal cancer patients of an ethnically homogenous population of Kashmir valley are closely related to continued exposure to various common dietary risk factors, especially hot salty tea, meat, baked bread and "Hakh", that are rich in nitrosoamines and familial cancer history.