Cultural Expression of Anxiety Symptoms in Kannada Language: A Qualitative Study.

Background: In anxiety disorders, culture is important in symptom presentation and help-seeking. Most tools for anxiety disorders are not validated in India and thus might not capture culture-specific aspects of anxiety. This study aims to identify and generate culturally specific terms to describe symptoms of anxiety as part of the development of the Kannada version of the Panic and Anxiety National Indian Questionnaire (PANIQ). The PANIQ is a tool under development to identify anxiety and panic in Indian settings. Methods: This study used qualitative methods like focus group discussions (FGDs) and in-depth interviews (IDIs) to identify and generate items related to anxiety and panic in Kannada from stakeholders like individuals with anxiety disorders, their caregivers, healthcare workers, and mental health professionals who treat individuals with anxiety and panic disorders. Five FGDs (n = 28), one triad (n = 3), and 34 IDIs (n = 34) were conducted. Results: The mean age of the participants was 38.9 (standard deviation: 12.28) years; 57.1% were from rural areas. We generated 615 Kannada items. These were classified into 21 domains and facets. Items in domains like Somatic symptoms, Fear, and Impairment in day-to-day life were higher than those noted in existing tools for anxiety that focus more on cognitive symptoms of anxiety. Conclusions: This study generated culturally specific items of anxiety through a qualitative process of tool development incorporating subjective experiences of persons with anxiety disorders and other stakeholders. This is among the first steps toward the development of PANIQ.

Coping with autism during lockdown period of the COVID-19 pandemic: A cross-sectional survey.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is thought to have greatly impacted families of individuals with autism spectrum disorder (ASD) due to lockdown, given lack of access to healthcare, therapy, and day-care centers. This survey was conducted to understand the magnitude of the impact of lockdown, and its effect on the health and behavior of individuals with ASD and their families. MATERIALS AND METHODS: We conducted an anonymous online survey, disseminated to families registered with our hospital and collaborating centers. The survey questionnaire collected information on sociodemographic details, details of the patient's and parents' behavior and health during the COVID-19 lockdown, and treatment details of the patient. RESULTS: A total of 153 families completed the survey. Of the 153, nearly half of the individuals with ASD had an inadequate understanding of lockdown, 54% had increased screen-time, while a third reported new-onset behavioral changes. About 40% received online therapies, of which 85% reported benefits. Of the 132 who answered the parent's section, 55% reported decreased interest and/or pleasure in doing daily activities and 43% felt depressed and/or hopeless. About 80% of families reported short-term positive changes such as improved speech, language skills, and participation in household chores. CONCLUSION: The COVID-19 pandemic has disrupted routines, triggered behavioral issues in individuals with ASD, and impacted the coping skills of both individuals and families, along with the mental health and well-being of the family. Valuable suggestions to improve therapy services and clinical care using technology have been uncovered and need to be explored.

Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry.

The COVID19 pandemic is an unprecedented disaster. In India, the spread of COVID19 infection and the subsequent lockdown coincided with a crucial period of the annual examination in almost all educational institutions. The pandemic has created hurdles in the conduct of examination due to many reasons, some of which are spread of infection and associated safety issues, lack of public transport for patients as well as the postgraduates in outstation and examiners, and lack of workforce due to round-the-clock service for rendering health services leading to difficulty in arranging logistics at the examination center. Currently, there are no guidelines or policies on how examinations need to be carried out during such a pandemic. Hence, there is an urgent need to look at solutions within the profession for the completion of examination. Teachers of psychiatry play an important role in the national mental health services. Their expertise can be valuable for finding solutions that work. This article has compiled suggestions from Indian teachers of psychiatry.

A Survey among Teachers of Psychiatry to Improve the Quality of Undergraduate Training: Outcomes from Karnataka.

BACKGROUND: In India, there is a large gap between the mental health morbidity in society and the availability of psychiatrists. However, the latest Indian undergraduate medical curriculum does not require any competency in psychiatry to be fulfilled for certification of medical graduates as doctors. Thus, the role of Indian psychiatry teachers is quite challenging. Interestingly, there has been hardly any effort to understand the felt needs of psychiatry teachers that may further improve the quality of undergraduate training. METHODS: We used a survey questionnaire that was both qualitative and quantitative, with questions on topics such as years of psychiatry training and experience as a psychiatry teacher. Do they feel the need for training in undergraduate psychiatry teaching? Do they require training in teaching psychiatry theory or clinics or both? What are the specific areas where they want training? What more should be planned for psychiatry teachers? Based on an online survey further steps in the direction of psychiatry teachers felt needs were initiated. RESULTS: Around 55 responses with a response rate of 37% were received. More than 50% were working in medical colleges for the last 5 years. About 80% felt the need for further training to teach medical students while 97% felt that additional training is required for handling theory as well as bedside clinic. More than 60% were keen to attend a 1-day workshop to upgrade their teaching skills. A majority wanted to have a forum to share their experiences and to learn from others. Based on the felt needs of psychiatry teachers from the survey, a 1-day workshop was carried out and a forum for psychiatry teachers was inaugurated. CONCLUSION: Training of psychiatry teachers is an important felt need for the challenges that are unique to Indian medical education. The outcome from the Karnataka survey is a progressive step in addressing this challenge.

Neurocognitive and clinical correlates of insight in schizophrenia.

BACKGROUND: Schizophrenia is a heterogeneous disorder characterized by various symptom dimensions and neurocognitive deficits. Impairment of insight is a core clinical symptom of the disorder. There has been an increasing focus on neurocognition and insight in schizophrenia; although, many studies fail to control for premorbid cognitive status. MATERIALS AND METHODS: Schizophrenia patients (n = 60) selected for adequate background education were recruited from outpatient services of a tertiary care hospital and community care homes in Southern India. These patients were comprehensively assessed using a neurocognitive battery. Clinical assessments were done using the Positive and Negative Syndrome Scale (PANSS) and Schedule for the Assessment of Insight-expanded version (SAI-E). Partial correlation was performed to examine the relationship of insight with clinical and neurocognitive measures. Statistical significance was set at P = 0.004 (Bonferroni correction for 12 tests of association). Linear regression analysis was performed to examine the predictors of insight. RESULTS: The mean PANSS positive, negative, general psychopathology, and total scores were 14.2 ± 4.9, 17.4 ± 5.0, 34.3 ± 6.8, and 65.8 ± 13.9, respectively. Mean insight score (SAI-E) was 8.5 ± 2.9. In partial correlation done after controlling for IQ, significant negative correlations were observed between insight score and the Wisconsin Card Sorting Test (WCST) total errors (P = 0.001), WCST perseverative errors (P < 0.001). Insight scores had negative correlations with PANSS negative (P < 0.002) and total scores (P < 0.002). WCST perseverative errors were the primary predictor of insight in the regression analysis. CONCLUSION: Insight has a strong relationship with executive functioning in schizophrenia. This could indicate shared neurobiological substrates for insight and executive functioning.

The Effectiveness of a Brief Psychological Intervention for Patients with Diabetes-Related Distress.

BACKGROUND: Diabetes-related distress (DRD) is the negative emotional and psychological reaction to living with diabetes mellitus (DM). DRD has been reported to affect glycemic control and self-management practices adversely. Limited research is available on the effectiveness of psychological interventions for DRD. We aimed to study the effectiveness of a brief psychological intervention for patients with DRD. METHODS: The findings of a targeted brief psychological intervention conducted for patients with DRD, as a part of psycho-endocrinology liaison services in a general hospital, are reported. Details regarding the assessment and intervention given were collected from the patients' records. Forty-one patients with DRD diagnosed using Diabetes Distress Scale (DDS) were given the single session intervention consisting of brief diabetes education focusing on physical activity and medication adherence, relaxation techniques, and illness-specific problem-solving strategies. Effectiveness was assessed using change in Clinical Global Impression-Severity (CGI-S), patient-rated visual analog scale, brief physical activity questionnaire, and medication adherence at baseline and 2-month follow-up. RESULTS: Analysis using Wilcoxon signed rank test found a significant change in the follow-up scores on all the assessment scales. CONCLUSIONS: The study highlights the benefits of brief intervention for reducing DRD, thus reducing the emotional burden of living with DM.

Do SADQ and AUDIT identify independent impacts of alcohol abuse - clinical and biochemical markers respectively?

BACKGROUND AND OBJECTIVES: We have analyzed extant data to see if Alcohol Use Disorder Identification Test (AUDIT) and Severity of Alcohol Dependence Questionnaire (SADQ) assess overlapping aspects of alcoholism, and how they relate to lab measures of alcoholism. MATERIALS AND METHODS: Consecutive male patients between 20 and 50 years were recruited from varied departments of a general hospital. AUDIT and SADQ, as well as liver function tests, were part of the data obtained. RESULTS: Despite, a significant correlation between total scores of SADQ and AUDIT (ρ = 0.188, P < 0.021) and some of their sub-scores. SADQ scores alone were significantly correlating with clinical variables of alcoholism such as family history and age of onset; AUDIT did not. On the other hand, AUDIT total scores correlated with total and conjugated bilirubin, while SADQ did not. INTERPRETATION AND CONCLUSION: Our data suggests that the two scales, AUDIT and SADQ may be tapping into two different outcomes of increased alcohol use namely clinical and biochemical markers, respectively. SADQ could be useful in studies looking at withdrawal related severity and clinical aspects of alcoholism; while AUDIT could be more suitable for studies looking at alcoholism-related medical morbidity. This needs to be confirmed in larger unselected samples from different community and clinical settings.

Issues related to obtaining intelligence quotient-matched controls in autism research.

BACKGROUND: Intelligence Quotient (IQ) is considered to be an index of global cognitive functioning and has traditionally been used as a fulcral measure in case-control studies in neuro-developmental disorders such as autism. AIM: The aim is to highlight the issues of "matching for IQ" with controls in autism research. MATERIALS AND METHODS: Percentile scores on the Coloured Progressive Matrices of 20 children with autism in the age range of 5 to 12 years have been graphically compared with 21 age matched typically developing children. RESULTS AND CONCLUSIONS: The percentile scores of the so-called high functioning children with autism from special schools were well below that of typically developing children. There are many challenges when using IQ in case-control studies of autism. Alternative approaches need to be considered.

Stress and quality of life in psoriasis: an update.

Psoriasis is a chronic, relapsing, cutaneous condition with 1-2% prevalence in the general population. There are many factors involved in the induction and/or exacerbation of psoriasis of which stress is a well-known trigger factor in the appearance or exacerbation of psoriasis. Stress reaction in patients with psoriasis is probably mediated by the hypothalamic-pituitary-adrenal relationship with immunologic effects. Stress response involves increased levels of neuroendocrine hormones and autonomic neurotransmitters. Psychological stress or an abnormal response to stressors has been found to modify the evolution of skin disorders such as psoriasis. It can also have substantial psychological, and psychosocial impact on a patient's quality of life. Treatment regimens include stress-reduction strategies, such as biofeedback, meditation, yoga, and self-help approaches. This review focuses the relationship between psoriasis and stress, especially relating to psychosocial, psychological, and emotional stress aspects.

Schizophrenia impairs phonological speech production: a preliminary report.

INTRODUCTION: Schizophrenia causes clinically conspicuous impairment of syntax and semantics as part of the disorganisation syndrome; however, little is known regarding its effect on the phonological stage of speech, where word meanings are resolved into speech imagery. METHODS: We used a "tongue-twister" task to probe phonological speech production and its clinical associations in six schizophrenia patients and 16 controls. RESULTS: Errors induced by phonological similarity were more common in the patients (p=.003), were positively associated with psychomotor poverty symptoms (p=.02) and negatively associated with reality distortion symptoms (p=.03). CONCLUSIONS: Our findings suggest that phonological speech production is markedly disrupted by schizophrenia. Further, this phonological abnormality is distinct from disorganisation syndrome.

Time perception and its neuropsychological correlates in patients with schizophrenia and in healthy volunteers.

Disordered time perception has been reported in schizophrenia. We investigated time perception dysfunction and its neuropsychological correlates in patients with schizophrenia. Participants comprised 38 patients and 38 age- and sex-matched healthy volunteers who were compared in an auditory temporal bisection paradigm using two interval ranges (a 400/800 ms condition and a 1000/2000 ms condition). In the temporal bisection, subjects were required to categorise a probe duration as short or long, based upon the similarity with two reference durations. All subjects also completed a battery of neuropsychological tests measuring sustained attention, short- and long-term memory and executive function. In the 400/800 ms condition, patients judged durations significantly shorter than did control subjects. Patients also exhibited decreased temporal sensitivity in both conditions. We found in both groups a negative association between temporal sensitivity and sustained attention for the 400/800 ms condition, and between temporal sensitivity and long-term memory for the 1000/200 ms condition. In patients, short-term memory performance was negatively associated with duration judgement in both conditions, while executive dysfunction was correlated to a general performance deficit in the 400/800 ms condition. These findings suggest the possibility that time perception abnormalities in schizophrenia are part of neuropsychological dysfunction and are likely to adversely impact upon activity of daily living.

Neurocognitive basis of insight in schizophrenia.

People with schizophrenia have been categorised into three groups: those with full insight (aware, correct attributers); those aware of being unwell, but who misattributed their symptoms (aware, incorrect attributers); and those unaware of being ill (unaware). Cluster analysis of 'awareness of illness'and 'relabelling of symptoms'scores on the Schedule for the Assessment of Insight confirmed three distinct subgroups. The unaware group were impaired on executive and memory tests, whereas those in the aware, misattributing group were cognitively intact. Findings support an association between unawareness of illness and executive dysfunction, and highlight the separation of symptom misattribution from unawareness of illness.

Executive dysfunction screening test for neuropsychiatric disorders.

The Analogies Understanding Test (AUT) was developed as a brief cognitive screening task of executive problem solving. A few of the test items at the beginning are "facilitated" as a means of engaging patients. Individuals with schizophrenia and mild Alzheimer's Disease (AD) made significantly less correct responses than their control groups. The schizophrenia patients, but not AD patients, made significantly more perseverations than controls on the AUT. As expected, AUT performance in schizophrenia patients correlated with the Wisconsin Card Sorting test measures. Preliminary findings suggest that the AUT test may be useful as a measure of executive dysfunction in neuropsychiatric patients.