Psychosurgery in Indian Scenario: Time to Think with Phronesis.

With advances in technology, neurosurgical procedures are being examined for potential use in psychiatric conditions. However, the use of neurosurgical procedures in psychiatry carries the baggage of memories of psychosurgery. Different neurosurgical techniques carry their characteristic safety, efficacy, and complication profile. The introduction of deep brain stimulation has generated a new interest in surgical treatment with a distinct advantage over lesioning procedures used in the past. In such a scenario, it is essential that an informed discussion takes place regarding the use of these neurosurgical procedures in psychiatric disorders such that patient safety, informed consent, regulatory requirements, and research are taken care of.

Task sharing for the management of leprosy by nurses in a tertiary healthcare setting of Northern India.

BACKGROUND: This study aimed to assess the effectiveness of nurse-led interventions in managing leprosy due to a shortage of dermatologists and other healthcare professionals. METHODS: A total of 100 leprosy patients were divided into experimental (n=50) and control groups (n=50). The intervention included face-to-face counseling by a trained nurse, motivational videos and exercise demonstrations. The control group received standard care. The primary outcome of interest was treatment adherence (Adherence to Refills and Medications Scale); other assessed outcomes included changes in perceived stigma (Stigma Assessment and Reduction of Impact scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder seven-item) and quality of life (WHO QOL-BREF Scale) from baseline to week 8. RESULTS: The intervention group had better treatment adherence (p<0.001). At baseline, moderately severe and severe depression prevalence was 18% and 28%, respectively, and anxiety was 25%, with no intergroup differences. Anxiety significantly decreased in the intervention group (p<0.001), but depression remained similar (p=0.291). Perceived stigma improved notably, especially in disclosure of concern (p<0.001), internal stigma (p<0.001) and anticipated stigma (p<0.001). Quality of life scores improved in the intervention group vs controls. CONCLUSION: Nurse-led interventions effectively enhanced quality of life and treatment adherence and reduced anxiety, depression and perceived stigma among leprosy patients. The study recommends strengthening the capacity of nurses for active involvement in leprosy care.

Portable Neuroimaging-Guided Noninvasive Brain Stimulation of the Cortico-Cerebello-Thalamo-Cortical Loop-Hypothesis and Theory in Cannabis Use Disorder.

BACKGROUND: Maladaptive neuroplasticity-related learned response in substance use disorder (SUD) can be ameliorated using noninvasive brain stimulation (NIBS); however, inter-individual variability needs to be addressed for clinical translation. OBJECTIVE: Our first objective was to develop a hypothesis for NIBS for learned response in SUD based on a competing neurobehavioral decision systems model. The next objective was to develop the theory by conducting a computational simulation of NIBS of the cortico-cerebello-thalamo-cortical (CCTC) loop in cannabis use disorder (CUD)-related dysfunctional "cue-reactivity"-a construct closely related to "craving"-that is a core symptom. Our third objective was to test the feasibility of a neuroimaging-guided rational NIBS approach in healthy humans. METHODS: "Cue-reactivity" can be measured using behavioral paradigms and portable neuroimaging, including functional near-infrared spectroscopy (fNIRS) and electroencephalogram (EEG) metrics of sensorimotor gating. Therefore, we conducted a computational simulation of NIBS, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) of the cerebellar cortex and deep cerebellar nuclei (DCN) of the CCTC loop for its postulated effects on fNIRS and EEG metrics. We also developed a rational neuroimaging-guided NIBS approach for the cerebellar lobule (VII) and prefrontal cortex based on a healthy human study. RESULTS: Simulation of cerebellar tDCS induced gamma oscillations in the cerebral cortex, while transcranial temporal interference stimulation induced a gamma-to-beta frequency shift. A preliminary healthy human study (N = 10) found that 2 mA cerebellar tDCS evoked similar oxyhemoglobin (HbO) response in the range of 5 × 10-6 M across the cerebellum and PFC brain regions (α = 0.01); however, infra-slow (0.01-0.10 Hz) prefrontal cortex HbO-driven phase-amplitude-coupled (PAC; 4 Hz, ±2 mA (max)) cerebellar tACS evoked HbO levels in the range of 10-7 M that were statistically different (α = 0.01) across these brain regions. CONCLUSION: Our healthy human study showed the feasibility of fNIRS of cerebellum and PFC and closed-loop fNIRS-driven ctACS at 4 Hz, which may facilitate cerebellar cognitive function via the frontoparietal network. Future work needs to combine fNIRS with EEG for multi-modal imaging for closed-loop NIBS during operant conditioning.

Quality of life and psychological morbidity in patients with superficial cutaneous dermatophytosis.

We are facing an onslaught of chronic and recurrent dermatophytosis in epidemic proportions never encountered previously. There is a dearth of studies assessing the quality of life (QoL) and psychological morbidity in patients with superficial dermatophytosis. Our aim was to assess QoL and psychological morbidity in a sample of Indian patients suffering from dermatophytosis by using Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire (GHQ), respectively. This was a single-centre, cross-sectional study where consecutive patients of first episode, chronic or recurrent dermatophytosis were invited to participate. In addition to DLQI and GHQ12, patients' demographic data, duration and symptoms of dermatophyte infection, were also documented and recorded in the case record form. We recruited 196 patients who satisfied the inclusion criteria. The mean total DLQI score was 13.41 ± 7.56 (range 0-30). The main items in the questionnaire influenced by the disease were "symptoms and feelings," followed by "daily activities," "leisure" and "personal relationships." Age of the patient and body surface area involved had a significant impact on the QoL in our study (P ≤ 0.05). The mean GHQ-12 score was 16.98; 84.9% of patients had a score higher than or equal to 12 indicating significant psychological distress. GHQ-12 was found to have significant correlation with the DLQI score. Quality of life issues and psychosocial aspect should be considered while managing dermatophytosis as education about the disease, its management and prognosis may go a long way in improving the adherence to treatment and overall outcome in these patients.

Complicated alcohol withdrawal presenting as self mutilation.

Self-mutilation has been defined as deliberate self injury to body tissue without the intent to die. There has been an association between substance abuse and self mutilation. Alcoholic hallucinosis is usually in auditory modality and regarded as harmless. But patients can indulge in self harm behavior when the hallucinosis is commanding type. We are presenting a case in which the patient inflicted multiple stab injury to his own abdomen in response to alcoholic hallucinosis. This has clinical implication to enquire about substance abuse in patients presenting to emergency setting.