Association between common mental disorder and glycemic control in women with gestational diabetes: A mixed-method study.

Background: Gestational diabetes mellitus (GDM) is associated with an increased risk of mental health disorders among pregnant women. Poor mental health can negatively impact glycemic control in women with GDM, leading to adverse outcomes for both the mother and the baby. Aim: To determine the prevalence of common mental disorder (CMD) in women with GDM and its association with poor glycemic control. Additionally, to explore the reasons and coping strategies for CMD in women with GDM. Methods: A sequential explanatory mixed-method study was conducted among 351 women with GDM visiting a tertiary care hospital. The prevalence of CMD was assessed using Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Perceived Stress Scale (PSS). Glycemic control was determined based on two-hour postprandial blood glucose levels. In-depth interviews were conducted with six women who screened positive for CMD and had poor glycemic control. Data were analyzed using SPSS v23 and stats v12. Chi-square test and Poisson regression were performed, and adjusted prevalence ratios (aPRs) were reported. Results: The prevalence of CMD was found to be 19.08% (95% CI: 15.32%-23.52%), with 18.2% (95% CI: 14.5%-22.6%) anxiety symptoms 8.3% (95% CI: 5.8%-11.6%) depressive symptoms and stress each. CMD was significantly related to poor glycemic control (aPR: 1.58; 95% CI: 1.23-2.03; P value <0.001). The qualitative analysis revealed individual, family, health, and facility factors influencing mental health and glycemic control. Conclusion: Common mental health disorders are prevalent in women with GDM. It has a negative association with glycemic control. Implementing a routine screening program in the ANC clinic can aid in early identification and prompt management of the CMD and its associated complications.

Sociodemographic and clinical profile of patients receiving disability certificates for psychiatric disorders: An Indian Psychiatric Society Multicentric study.

Aim: To study the sociodemographic and clinical profile of subjects receiving disability certificates (DCs) issued for psychiatric disorders across multiple centres in India. Materials and Methods: Eleven centres, including ten government and one non-governmental organization spread across the country, participated in the study. Data on the sociodemographic and clinical profiles of patients who were issued DC in the calendar year 2019 were collected on a proforma designed for the study. Results: Overall, 2018 patients were issued DC for various psychiatric disorders across 11 centres in 2019. The number of certificates issued across different centres varied from 34 to 622. In terms of diagnostic profile, intellectual disability accounted for most of the certificates issued. In terms of psychiatric diagnosis, schizophrenia was the most common psychiatric diagnosis, followed by bipolar disorder, for which a DC was issued. When the diagnosis was considered, centre wise, intellectual disability (6 centres), mental illness (MI; 4 centres), and autism and specific learning disability (1 centre) accounted for the most DCs issued. Schizophrenia (9 centres), bipolar affective disorder (1 centre), and dementia (1 centre) were the most common MI for which DC was issued. Across centres, more than two-thirds of DC were issued to males. Conclusion: There is a wide variation in the number and clinical profile of DC issued across centres.

Severity of loneliness, depression and perceived social support in adults in the empty nest stage of the family life cycle and the influence of using digital technology.

PURPOSE: Study aimed to identify association between loneliness, depression and perceived social support in adults living in the empty nest stage of family life cycle and to assess impact of digital technology use on the same. METHODS: In this hospital based cross-sectional study, we recruited 281 adults aged 50 years and above. Assessment of loneliness and depression was done using University of California Los Angeles Loneliness scale and Patient Health Questionnaire. Social support was assessed using Multidimensional scale of perceived social support. Digital technology use was assessed based on their self -reported use of mobile, or computer. RESULTS: Among the participants (age 50-75 years), women accounted for 57.7%. 71% of the adults were staying with the spouse, 85% of the participants reported lowincome status. Mean score (SD) of loneliness was 61.7(10.23). Only 17.8% were classified as having no to mild depression, while 52.7% reported low social support. Loneliness severity correlated significantly with depression severity (σ = 0.59, p = 0.000), and perceived social support (σ = -0.78, p = 0.000). Use of digital technology (72.9%) was associated with significantly lower loneliness score (U=4120.00, p = 0.000, lower depression score (U=5106.00, p = 0.000) and higher perceived social support (U=4366.00, p = 0.000). CONCLUSION: Loneliness is present in adults in the empty nest stage of life cycle. Its severity positively correlated with depressive symptoms and negatively with perceived social support. Digital technology users seem to have lower loneliness, lower depression severity and higher social support compared to non-digital technology users.

Risperidone Reduces Matrix Metalloproteinase-9 and Increases Neurotrophin-3 in Schizophrenia Spectrum of Disorder.

Even though earlier studies have reported alteration in the markers of synaptic plasticity (Matrix metalloproteinase-9 [MMP-9] and Neurotrophin-3 [NT-3]), there are no reports about the effect of risperidone on the same. The present study was designed to assess the effect of risperidone on NT-3 and MMP-9 levels in patients with schizophrenia spectrum of disorder and to investigate whether these markers can be used to predict the treatment response in these patients. 62 schizophrenia spectrum of disorder patients were enrolled in the study and were treated with 4 mg of risperidone OD. Serum NT-3 and MMP-9 levels were compared at baseline and after 6 weeks following risperidone treatment. Severity of the disease was assessed using Positive and Negative Syndrome Scale (PANSS). MMP-9 was significantly reduced and NT-3 was significantly increased in schizophrenia spectrum of disorder after treatment with risperidone. We also found a significant reduction in MMP-9 levels in the non-responders group. At a cut off of 1225 ng/mL, MMP-9 can predict response to treatment with 64% sensitivity and 62% specificity and at a cut off of 957 pg/mL, NT-3 predicted the response to treatment with 60% sensitivity and 62% specificity. We conclude that risperidone decreases the serum levels of MMP-9 and increases the NT-3 levels in schizophrenia spectrum of disorder. MMP-9 and NT-3 can predict the response to treatment with risperidone.

Association of VDBP (rs4588 and rs7041) gene polymorphisms with susceptibility to postpartum depression in South Indian population: A cross-sectional study.

Low vitamin D levels have been implicated in postpartum depressive disorders (PPD). Our study aimed to demonstrate the association of Vitamin D Binding Protein (VDBP) genetic variants rs7041 and rs4588 with susceptibility to PPD and to investigate their possible relationship with serum vitamin D and VDBP levels in Indian women with PPD. A cross-sectional study involved 330 cases and 330 controls. Depressive symptoms were assessed using Edinburg Postnatal Depression Scale. Genotyping of SNPs was done by Taqman 5'allelic discrimination assay. Estimation of serum 25 hydroxyvitamin D [25(OH) D] and VDBP levels were done by ELISA. Serum total, free and bioavailable 25(OH) D levels were significantly lower in cases compared to controls, with similar levels of VDBP between the two groups. The study results showed that the VDBP rs4588 variant genotype AA was significantly associated with lower circulating levels of total 25(OH) D in cases. Also, the VDBP rs7041 variant TT genotype demonstrated significantly lower levels of total, free and bioavailable 25(OH) D levels in controls. However, VDBP rs7041 and rs4588 variants were not associated with PPD susceptibility. Also, VDBP haplotypes showed no association with PPD susceptibility. Our results demonstrated that VDBP polymorphisms rs4588 and rs7041 and their haplotypes are not associated with PPD susceptibility in the South Indian population. However, vitamin D levels were found to be influenced by the risk genotypes of VDBP SNPs rs4588 and rs7041.

Predictive validity of ESSENCE Q screening tool for early detection of neurodevelopmental disorder in children.

INTRODUCTION: Neurodevelopmental disorders (NDD) are a group of conditions that typically manifest early during the child's development with lifelong consequences. Early identification using efficient screening tools can positively modify the natural history of the disorder. ESSENCE Q is a simple questionnaire to detect ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations to reflect the co-existence of NDDs in children less than five years). There are limited studies on the validity of ESSENCE Q in detecting NDDs in young children in India. METHODS: We did a cross-sectional study in a tertiary care hospital to evaluate the validity of ESSENCE Q in detecting neurodevelopmental disorders. We translated the ESSENCE Q and subsequently used it to screen for NDD in 100 children aged 12-60 months. Clinical consensus diagnosis by two experienced experts was taken as the gold standard. RESULTS: 23% were diagnosed as having NDD as per the clinical consensus diagnosis. Around half the children (46%) were "at-risk for NDD" based on the ESSENCE Q scale. We found an optimal cut-off for ESSENCE Q of more than or equal to 4 with a sensitivity of 96%, a specificity of 82%, and a Youden index of 0.77. CONCLUSION: ESSENCE Q has good predictive validity to be used as a quick and easy screening tool to detect NDDs in young children under the age of 5 years.

Content validation of school readiness module and school readiness scale for assessing school readiness in children with autism spectrum disorder.

BACKGROUND: There is a paucity of research on interventions targeting preschool children with autism spectrum disorders (ASD) for school readiness. OBJECTIVES: The objectives of this study are to develop and validate a school readiness module for making children with ASD ready for inclusive education and a scale to assess school readiness in them. METHODS: Based on literature review, principles of learning, and techniques of behavioral intervention, a module was developed and reviewed by independent experts regarding the utility of the contents. A scale to assess school readiness was also developed to measure the impact of administering the module on children with ASD which was also validated by the same set of experts. Lawshe's content validity ratio was used to assess the appropriateness of each item for inclusion in the module and scale. RESULTS: Experts (n = 6) gave their opinion on the usefulness of the School Readiness module for children with ASD. The experts agreed that most of the content under each component were valid with the exception of identification of objects by function, identification of environmental sounds and answering social questions. Similarly, in the school readiness scale there was good agreement for all items except for 1 item under domain 2 and 2 items under domain 5. CONCLUSION: A school readiness module and a scale to assess school readiness based on interventions provided as per the school readiness module were developed and validated. Further studies are needed to assess the utility of the module and scale in children with ASD.

More students with anxiety disorders in urban schools than in rural schools: A comparative study from Union Territory, India.

A significant number of adolescents have difficulty during student life and suffer with anxiety disorders that go undetected and untreated. The lack of data exists in this arena in India. This study aimed to assess anxiety disorders among adolescent students in urban and rural areas and compared the differences between these two locations. A cross-sectional, comparative study was carried out among 462 adolescents studying in rural and urban Government schools using stratified cluster random sampling. Data collected on a pre-designed proforma on demographic parameters and used the Screen for Child Anxiety Related Emotional Disorders (SCARED) scale for detecting anxiety disorders. Out of 462 subjects, females outnumbered males (n = 237, 51.3 %). The mean age of the sample was 15.85+/-0.7 (years); 167 (36 %) subjects had anxiety disorders. All specific anxiety disorders except 'school avoidance' were significantly more in urban school students than in rural students (66.5 % vs. 33.5 %). In a binary logistic regression model, gender (female > male), and locality (urban student > rural student) were significant predictors of the presence of anxiety disorder in this adolescent sample. Adolescent students from the urban schools had a higher prevalence of any anxiety disorder, as well as for specific sub-types than the students from the rural schools.

Reduced Maternal Serum Total, Free and Bioavailable Vitamin D Levels and its Association with the Risk for Postpartum Depressive Symptoms.

BACKGROUND: Low vitamin D levels have been implicated in postpartum depressive disorders. However, studies on bioavailable vitamin D levels in postpartum depression are limited. Our study aimed to assess the serum concentrations of total, free and bioavailable 25-hydroxyvitamin D (25(OH)D) levels in women with postpartum depressive symptoms (PPD) and the association between 25(OH)D levels and PPD at 6 week post-delivery. METHODS: In this cross-sectional study, a total of 330 cases and 330 age and BMI matched controls were recruited from the tertiary care hospital in South India. Women with depressive symptoms were assessed using the validated Edinburg Postnatal Depression Scale (EPDS) and cut-off score ≥10 was used. Serum 25(OH)D and VDBP levels were measured using commercially available ELISA kits. RESULTS: Serum total, free and bioavailable 25(OH)D levels were significantly lower in postpartum depressive women compared to non-depressive women (p <0.001, p = 0.01). A significant negative correlation was observed between 25(OH)D, free 25(OH)D and bioavailable 25(OH)D with EPDS score in total study subjects (p <0.001, r = -0.19; p <0.001, r = -0.14 and p <0.001, r = -0.14). Multivariate linear regression analysis further confirmed a significant association between serum total, free and bioavailable 25(OH)D levels and EPDS score (p <0.001∗). CONCLUSIONS: Our study demonstrated that lower serum total, free and bioavailable 25(OH)D levels were associated with postpartum depressive symptoms. Hypovitaminosis D after delivery may be a risk factor for postpartum depression.

Interleukin-17 and Interleukin-10 Association with Disease Progression in Schizophrenia.

BACKGROUND: Alteration in cytokine levels are known to be involved in the pathogenesis of schizophrenia. OBJECTIVES: To estimate the serum levels of interleukin-17 (IL-17) and interleukin-10 (IL-10) and their association with disease progression in schizophrenia. METHODS: A total of 67 schizophrenia cases were enrolled in the present study. IL-17 and IL-10 were estimated by enzyme-linked immunosorbent assay. Positive and Negative Syndrome Scale (PANSS) was used to evaluate disease severity. RESULTS: IL-17 was positively correlated with positive symptom score (r = 0.256, p = .036), general psychopathology score (r = 0.255, p = .038) and total score (r = 0.273, p = .025) in schizophrenia. IL-17 and IL-10 were significantly increased in schizophrenia cases with PANSS more than 85 compared to those with 71-85. CONCLUSION: IL-17 and IL-10 are associated with disease severity in schizophrenia but are not good markers for predicting the disease progression.

Cognitive performance and psychosocial functioning in unaffected siblings of bipolar disorder patients in comparison with healthy controls.

We aimed to evaluate the cognitive domains for endophenotypes and their bearing on psychosocial functioning in unaffected siblings of patients with bipolar type I disorder (BD-I). We recruited unaffected siblings (n = 60) and age (±2 years), gender and education-matched healthy control subjects (n = 60) after screening with Structured clinical interview for DSM-IV-TR axis I disorders (SCID-I) - Research Version, Young Mania rating scale (YMRS), Hamilton depression rating scale (HDRS) and Family Interview for Genetic Studies scale (FIGS). Cognitive functioning was evaluated using Addenbrooke's Cognitive Examination III Revised (ACE-III R) and Trail making tests A and B, whereas psychosocial functioning was evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). The siblings had scored significantly lower in memory tasks of ACE-III R (p < 0.001) than controls, whereas other cognitive domains were comparable. Psychosocial functioning did not differ significantly between the groups. No correlation existed between cognitive performance and psychosocial functioning. Memory functions can be considered as a possible endophenotype for BD-I.

Do Tamil newspapers educate the public about suicide? Content analysis from a high suicide Union Territory in India.

BACKGROUND: Responsible media reporting of suicide is a key population-level suicide prevention strategy. Thus far, there has been no systematic analysis of media reporting of suicide in Puducherry, a consistently high suicide burden state in India. AIM: To evaluate the adherence of media reports of suicide against the World Health Organization (WHO) guidelines in Puducherry. METHOD: We conducted a year-round content analysis of all suicide-related reports in the two most widely read vernacular dailies of Puducherry. We used a pre-defined data extraction form and coded each item based on the WHO reporting guidelines. RESULTS: A total of 318 suicide reports were retrieved. Harmful reporting practices such as mentioning the method of suicide (99.1%), description of the steps involved (68.2%) and location of suicide (86.5%), monocausal explanations (91.8%), and inciting life events (52.5%) were common. Helpful practices such as mentioning warning signs (1.3%), recognizing links with mental health disorders (3.8%) and effects on bereaved persons (2.2%) were rare. Only one article (0.31%) included any content related to educational/preventive aspects of suicide. CONCLUSION: Media reporting of suicide in Puducherry, India, does not adhere to reporting guidelines and there is very little focus on educating the public about preventive aspects of suicide. Urgent efforts are warranted to improve the quality of media reporting which should include the development of national guidelines on suicide reporting and collaborative efforts that take into account barriers and perspectives of media professionals.

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.

Five-Year Trend in Issuing Disability Certificates from a General Hospital Psychiatric Unit in South India.

BACKGROUND: Mental disability is a common condition but is considered as an invisible disability. The disability certificate in psychiatry remains underexplored. Some reasons are issues of confidentiality, stigma, lack of awareness in the public, and the hesitancy in the mental health professionals. We aim to provide a brief profile of patients with mental illness issued disability certificates from a psychiatric unit over a five-year period (2013-2017). METHODS: Our retrospective study is based on the data available from the copies of the issued disability certificates from a psychiatric unit that functions in a multispecialty tertiary care teaching government hospital in Southern India. Patients undergoing treatment in psychiatry apply for a disability certificate to the medical superintendent of the hospital. Each applicant undergoes a detailed workup to ascertain the diagnosis, and the mental disability is assessed using Indian Disability Evaluation and Assessment Scale (IDEAS). Those with intellectual developmental disorder (IDD) are assessed by a clinical psychologist for quantifying intelligence quotient, based on which the disability certificate is issued. Data were extracted and analyzed using SPSS. Descriptive statistics were used. RESULTS: Over five years, 258 disability certificates were issued. A total of 218 were for mental illness and 40 were for IDD. Schizophrenia was the commonest primary diagnosis. There was no gender predominance, nor the influence of gender on different domains of IDEAS except on work domain dysfunction due to mental illness. The validity period was not mentioned in 81% of the issued certificates for mental illness. CONCLUSIONS: This descriptive study found a lower number of certificates issued from the psychiatric unit. Schizophrenia remains the main psychiatric diagnosis for which a disability certificate was issued. We did not assess the utilization pattern of the issued certificates.

Suicide Prevention Strategies for General Hospital and Psychiatric Inpatients: A Narrative Review.

BACKGROUND: In-patient (IP) suicides contribute a small but significant proportion of overall suicides. Despite this, suicide prevention strategies focusing on the general hospital IP population remain relatively underresearched. This paper is intended to provide an overview of various proposed suicide prevention approaches in the general hospital, including psychiatric IP, settings, and their evidence base. METHODOLOGY: Electronic searches of MEDLINE through PubMed, ScienceDirect, and Google Scholar databases were performed to identify potentially relevant articles from inception till January 2019. The generated abstracts were systematically screened for their eligibility to be included in the review. Included articles were grouped under five broad themes: environmental modification, staff education, pharmacotherapy, psychotherapy, and brain stimulation. Data extraction was done using a structured proforma. RESULTS: Environmental modifications and educating the health care professionals appear to be the most promising strategies to reduce suicide-related mortality among IPs. Among pharmacological methods, ketamine has shown initial promise in reducing suicidal ideations. Follow-up data are lacking for most of the described methods. Limited but positive evidence exists for cognitive therapies focusing on the immediate postadmission period and brain stimulation techniques, and it warrants further replication. CONCLUSION: There is a striking paucity of original research on IP suicide prevention. Given the ethical and methodological issues in carrying out studies with IP suicide as the primary outcome, there is a need to focus on intermediate suicide outcome measures, such as knowledge, attitude, and skills among staff handlers of suicidal patients.

Psychomotor recovery of dexmedetomidine compared with propofol after sedation during spinal anesthesia: A randomized control trial.

BACKGROUND AND AIMS: Early psychomotor recovery is an essential part of day care surgery which depends on brain integration of motor and sensory co-ordination. Even though dexmedetomidine is commonly used for day care procedures, the recovery profile was not studied. Hence, this study was designed to evaluate the psychomotor recovery of sedation with dexmedetomidine during spinal anesthesia. MATERIAL AND METHODS: Sixty-six patients were included. Group D received dexmedetomidine 0.5 µg/kg (loading dose) followed by 0.2-1 µg/kg/hour. Group P received propofol infusion of 25-100 µg/kg/minute. Psychomotor recovery was assessed by finger-tapping, manual dexterity, visual spatial memory capacity, and pen and paper tests. Psychomotor tasks were given to the patients postoperatively at every 30 minutes for 2 hours followed by every hour up to 4 hours after surgery. Distribution of patients, age, weight, duration of surgery, and the level of sensory blockade was compared using independent t-test. Student's t-test has been used to find the significance of parameters such as heart rate, mean arterial pressure, oxygen saturation (SpO2), psychomotor recovery between two groups. P < 0.05 was considered as significant. RESULTS: The motor recovery using finger tapping test was faster in Group D than Group P (73.94 ± 42.13 vs 101.21 ± 37.98 minutes, P-value = 0.007). Motor recovery using peg board test was faster in Group P than Group D (82.12 ± 40.37 vs 99.39 ± 43.08 minutes, P-value = 0.098). Visual spatial capacity memory test and pen and paper test were unaffected. CONCLUSIONS: We conclude that patients who received dexmedetomidine showed earlier recovery with finger tapping test. Hence, we suggest to use dexmedetomidine for complete psychomotor recovery and fast-track discharging of the patient after spinal anesthesia.

Role of Social Support and Spouse Abuse in Low Birth Weight: A Case-control Study from Puducherry, India.

BACKGROUND: Low birth weight (LBW) is a major cause of neonatal morbidity and mortality. In addition to medical/clinical risk factors, various socio-demographic factors also have an impact on birth weight. OBJECTIVE: The objective of the study is to determine the association of antenatal social support and spouse abuse during pregnancy with LBW in Urban areas of Puducherry. MATERIALS AND METHODS: A community-based case-control study was conducted in Puducherry. Mothers of 100 LBW infants and normal birth weight infants in 2016 were studied. Functional Social Support Questionnaire and Index of Spouse Abuse scales were used. Conditional logistic regression for matched pair studies was done for multivariate analysis. RESULTS: Mean (± standard deviation) age and education of the study participants was 25.6 (±3.5) and 8.28 (±3.6) years, respectively. The proportion of girl child was 59% and 43% among cases and controls, respectively. Mothers with higher perceived social support (odds ratio [OR] = 0.5; 95% confidence interval [CI]: 0.4-0.7) had lesser odds of LBW. The odds of LBW was 3.6 (adjusted OR [aOR] = 3.6; 95% CI: 1.3-9.9) times and 6.9 (aOR = 6.9; 95% CI: 1.5-31.9) times greater among mothers who experienced nonphysical abuse and had pregnancy-induced hypertension respectively and it was statistically significant after adjusting for child's gender, social support, and parity. CONCLUSIONS: The presence of nonphysical abuse during the antenatal period increased the risk of LBW. The awareness should be created in the community to prevent maternal exposure to abuse.

Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital.

Alcoholism is one of the major health problems seen all over the world. The risk of relapse was estimated among 94 clients with alcohol dependence syndrome (ADS) who attended both in- and out-patient units of a tertiary care hospital. The tools used were the sociodemographic and clinical variables, Clinical Institute of Withdrawal Assessment Alcohol-revised (CIWA-Ar), Alcohol Use Disorder Identification Test (AUDIT), and Advanced Warning of Relapse (AWARE) scale. Out of the 94 clients, 63 (67.7%) were in the low-risk group for getting relapse, 26 (27.7%) were in the moderate-risk group, and 5 (5.3%) were in the high-risk group. Family history of alcohol use was significantly associated with the AWARE score (P < 0.05). Nicotine use was reported by 56 (59.6%) clients. Clients with a positive family history of alcohol use, disturbed sleep pattern, and higher total score (>20) of AUDIT scale were at higher risk of relapse.