Amisulpride as the antipsychotic of choice in severe psychotic disorder with comorbid impaired glucose tolerance.

Antipsychotics are the mainstay treatment for the majority of severe mental illnesses. Such patients are also more prone to develop medical comorbidities, which complicate the treatment decisions. It is estimated that up to 40% of individuals with schizophrenia have impaired glucose tolerance (IGT) or diabetes, which can be attributed to a combination of genetic, lifestyle, and medication-related factors. Some widely used antipsychotic medications like olanzapine, risperidone, and clozapine have been associated with an increased risk of weight gain, insulin resistance, and other metabolic abnormalities, which can worsen IGT and increase the risk of developing diabetes. Among second-generation antipsychotics (SGAs), amisulpride, aripirazole, and ziprasidone have a fairly low potency to cause obesity and hyperglycemia. In this context, clinicians must balance the benefits and risks of different antipsychotic medications and consider the individual's specific needs and preferences. Here, we shall discuss three cases, to ascertain how the use of amisulpride helped in glycemic control, and also reflect on probable etiologies leading to deranged glucose levels.

Algorithm-based approach to headache.

One of the most commonly encountered scenarios in any healthcare setting is a patient presenting with a headache. Yet, the assessment, diagnosis and treatment of headache disorders can be challenging and burdensome for even specialist doctors in medicine, psychiatry, oto-rhinology, neurology and so on. Apart from saving patient's and doctor's time as well as money, this article will buy leading time for better outcome and management of certain difficult headache disorders. The aim of this review is to simplify the approach to headache diagnosis for an early and proper referral. Literature search was done on PubMed and Google Scholar using key words. Only studies which were in English were considered. Sixty-one articles published from 1975 to 2022 were reviewed after screening for inclusion and exclusion criteria. It is very essential that a primary care physician is aware of the classification of headache. Red flag signs of high-risk headaches are essential for proper referral. It is also essential that we rule out secondary headaches as they are more life threatening. Vulnerable populations such as geriatric and paediatric populations require expert attention in case of headache disorders.

Reduced reward responsiveness in treatment resistant depression of middle-aged adults: Association with carotid artery stiffness and tetrahydrobiopterin.

Nearly one third of the population diagnosed with major depressive disorder (MDD) fail to respond to two or more antidepressant drugs of adequate dose and duration. This necessitates identification of confounding psychological and physiological factors that could contribute to treatment resistant depression (TRD). The present longitudinal study investigated the influence of behavioural inhibition system (BIS) and behavioural approach system (BAS) in treatment resistance. Further, the association of depression severity with physiological factors contributing to arterial stiffness was also investigated. Baseline data was acquired from 101 middle-aged (36-56 years) patients on immediate diagnosis with MDD using DSM-V criteria. Follow ups were conducted at 06 months and 12 months during treatment. Psychological assessment battery at baseline and follow ups comprised of Hamilton depression rating (HAM-D) for depression severity, WHODAS-2 and BIS-BAS score. Atherosclerosis and central arterial stiffness were measured by intima-media thickness of internal carotid artery and brachial-ankle pulse wave velocity. Physiological factors influencing central vascular function viz., body-mass index, estimated glomerular filtration rate, HbA1c, central systolic and diastolic blood pressure, heart rate and tetrahydrobiopterin were also investigated. Our results show lower reward responsiveness (BAS-RR) and higher BIS scores in TRD patients along with differentially higher intima-media thickness of left internal carotid artery. Higher depression severity at all stages of the study was correlated with lower tetrahydrobiopterin and BAS-RR scores. We, therefore, suggest that vascular depression resulting due to increased intima-media thickness of left carotid artery and lower tetrahydrobiopterin could be contributing factors for treatment resistance in middle-aged MDD patients.

Long-Term Changes in the Quality of Media Reporting of Suicide Following a Celebrity Suicide in India.

Online portals of selected English and local language newspapers and television channels were searched to identify suicide news reports published one year after the celebrity suicide (ACS). These reports (n = 1952) were compared with the corresponding period of the previous year, immediately following the celebrity suicide (ICS) (n = 2486), and a three-month period before the celebrity suicide (BCS) (n = 1381) to assess longitudinal changes in quality of media reporting. There was a decline in reporting of several potentially harmful characteristics over time such as mentioning the deceased's age and gender (p < .001 for both), and location of suicide (p < .001). The quality of media reporting of suicide was significantly better at one year compared to the period immediately following celebrity suicide. This change was mainly driven by an improvement in the reporting quality of English news reports while local language reports continued to remain poorly adherent to reporting guidelines.

Treatment resistant psychosis in children and adolescents and clozapine: Nuances.

With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group.

Suicide reporting of LGBTQI+ population in India: An analysis of online media reports of the past decade.

BACKGROUND: Imbalanced portrayal of suicide by the media can have adverse public health consequences. We aimed to evaluate the psychosocial context, as well as the quality of media reporting, of suicide among lesbian, gay, bisexual, transgender people, queer and intersex (LGBTQI+) population. METHODS: A cross-sectional study was conducted to evaluate online news reports discussing the suicide of LGBTQI+ persons published between January 2011 and January 2021. Psychosocial factors associated with suicide were extracted from the reports. Quality of suicide reporting was checked against international as well as locally relevant reporting guidelines. RESULTS: A total of 135 suicide reports from five newspapers were analyzed. Multiple psychosocial stressors were reported in 54.5% of the suicides. Social stigma was the most common factor associated with LGBTQI+ suicide. Several breaches of reporting were noted in relation to mentioning the identity (55.6%) and method of suicide (54.3%) in the title of report and inclusion of the deceased's photograph (20.4%). Potentially helpful reporting characteristics, such as including educational information (2.2%), mentioning warning signs (12.6%) and suicide support service details (3.7%), were rarely practiced. Local language news articles displayed more frequent and serious violations compared to English news reports. CONCLUSION: Indian media reporting of suicide among LGBTQI+ persons is poorly adherent to reporting guidelines.

Change in attitude and help-seeking pattern of caregivers and patients with mental disorders in the community - Recent findings from India.

Knowledge of factors related to patients' and primary caregivers' health-seeking behaviour is required for a complete early intervention for the management of mental illness. Previous research has found that men are more likely to seek care and that a considerable proportion of patients seek help from native healers before obtaining psychiatric help. The goal of this study was to see if there had been any changes in the paths to psychiatric care, as well as the socio-demographic characteristics that were linked to early help-seeking behaviour among patients with mental illnesses in metropolitan eastern India. Method: The researchers utilised a cross-sectional study design. A face-to-face interview was used to collect data using the WHO Encounter Form. Using a successive sample technique, patients with various diagnoses of mental illness undergoing Psychiatry outpatient therapy at a tertiary care medical college were included in the study. Results: In terms of gender, ladies (53.3%) were seen to use psychiatric services more than males (46.7%) from an urban or semi-urban background. For dissociative disorders, the median time from onset to first contact with a care provider was 0.1 years; 0.3 years for mood episodes; 0.6 years for anxiety disorders; one year for psychotic disorders; and seven years for Substance Use Disorders (SUD). However, interaction with current psychiatric services took an average of six months for dissociation; 3.5 years for mood disorders; three years for anxiety disorders; six years for psychotic disorders; and a maximum of seventeen years for SUD. Participants in the study who had a family history of mental illness sought care more quickly (OR = 4.3, 95 percent CI 1.19 to 7.11, P = 0.03). The fact that 73 percent of patients have a GP or mental health professional as their first point of contact for various mental diseases is good. Higher education status, urban background, dwelling closer to the mental health centre, and having a biological attribution model for psychological illness were the other clinical and demographic characteristics important for quicker paths to mental health treatment. Conclusions: In most cases of psychosis and SUD (substance use disorders), there is still a significant delay in receiving modern psychiatric therapy. The number of initial contacts with Native Healers ha s decreased. The majority of people said mental illness was caused by environmental or biological factors. Education and scientific information regarding mental health have aided the process of seeking treatment, and there should be a provision of training programmes for family physicians and community health professionals to facilitate the process of help-seeking behavior of psychiatric patients in the Indian subcontinent.

Quality of newspaper reporting of suicide in Odisha, India, against the World Health Organization guidelines.

Background: Imbalanced media reporting of suicide may increase suicide risk among vulnerable individuals. Aim: This study aims to assess the quality of suicide reporting in print newspapers of Odisha, a high suicide burden state in Eastern India. Materials and Methods: We analyzed all eligible media reports of suicide in selected English and local language printed newspapers of Odisha between October 1, 2019, and September 30, 2020. Quality assessment was carried out against international as well as local reporting guidelines. Results: A total of 248 news reports were analyzed. Majority of the articles reported identifying details (such as name [74.2%], age [60.9%], and gender [98.4%] of deceased) as well as a detailed description about the suicide event (suicide method [87.5%] and location [84.3%]). More than half (54.8%) of the reports attributed suicide to a single cause. Conclusion: Suicide reports in print newspapers of Odisha are poorly adherent to local and international suicide reporting guidelines.

Quality of media reporting following a celebrity suicide in India.

BACKGROUND: Celebrity suicides have the potential to trigger suicide contagion, particularly when media reporting is detailed and imbalanced. We aimed to assess the quality of media reporting of suicide of a popular Indian entertainment celebrity against the World Health Organization (WHO) suicide reporting guidelines. METHODS: Relevant news articles that reported the actor's suicide were retrieved from online news portals of regional and English language newspapers and television channels in the immediate week following the event. Deductive content analysis of these articles was done using a pre-designed data extraction form. RESULTS: A total of 573 news articles were analyzed. Several breaches of reporting were noted in relation to mentioning the word 'celebrity' in the title of report (14.7%), inclusion of the deceased's photograph (88.5%), detailed descriptions of the method (50.4%) and location of suicide (70.6%); local language newspapers were more culpable than English newspapers. Helpful reporting characteristics such as mentioning warning signs (4.1%), including educational information (2.7%) and suicide support line details (14.0%) were rarely practiced. CONCLUSION: Media reporting of celebrity suicide in India is imbalanced and poorly adherent to suicide reporting recommendations. Local language news reports display more frequent and serious violations in reporting as opposed to English news articles.

Changing trends in quality of media reporting of suicide in the community following a celebrity suicide in India.

OBJECTIVE: Little is known about changes in quality of media reporting of suicide in the community following a celebrity suicide. Our objective was to compare trends in quality of media reporting of suicide, before and after the suicide of an Indian entertainment celebrity, against the World Health Organization suicide reporting guidelines. METHOD: Online news portals of English and local language newspapers, as well as television channels, were searched to identify relevant suicide-related news articles. Comparison of reporting characteristics before and after the celebrity suicide was performed using chi-square test or Fisher's exact test. RESULTS: A total of 3867 eligible news reports were retrieved. There was a significant increase in harmful reporting characteristics, such as reporting the name, age and gender of the deceased (p < 0.001 for all comparisons), mentioning the location (p < 0.001) and reason for suicide (p = 0.04) and including photos of the deceased (p = 0.002) following the celebrity suicide. Helpful reporting practices were less affected; there was a significant rise in inclusion of expert opinion (p = 0.04) and mention of suicide-related warning signs (p = 0.02). CONCLUSION: Following a celebrity suicide, significant changes in the quality of media reporting of suicide were noted with an increase in several potentially harmful reporting characteristics.

Misconceptions Related to Covid-19 Infection Among the Medical Students During the Early Part of the Covid-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to widespread controversies related to the transmission, treatment, prevention, and management of COVID-19 infection. Medical students have been involved in patient care across the globe and many a times the general public looks forward towards the medical professionals to get proper information about various issues related to COVID-19. We aimed to evaluate the knowledge and misconceptions held by the medical students on various aspects of COVID-19 infection. SUBJECTS AND METHODS: An online cross-sectional survey was conducted through the Survey Monkey® platform using the Whatsapp®, among the medical undergraduate students of a tertiary care Institute of Eastern India. RESULTS: 236 medical students (of different years of medical training/MBBS) participated in the survey and the response rate to the survey was 47.2%. The mean age of the participants was 20.91 (SD-1.86) years, and about three-fifths were males (58.5%). One-third students were either in their first year of MBBS (31.8%) or the final year (35.16%) of MBBS. Incorrect beliefs related to various preventive aspects, risk of increasing chance of getting infection and modes of spread of infection were present in a significant proportion of students, with a wide variation for specific issues. When the number of participants with at least one incorrect related to any of the aspects of COVID-19 infection was evaluated, it ranged from 59% to 85% in different domains. CONCLUSIONS: This survey highlights the widespread prevalence of misconceptions about various aspects of COVID-19 among medical students, which needs to be addressed by proper education and awareness.

COVID-19 and suicides in India: A pilot study of reports in the media and scientific literature.

BACKGROUND: Our objective was to analyze reports of COVID-19 related suicides (CRS) to identify associated factors with a broader goal to inform management and prevention strategies. METHODS: We searched scientific literature, government websites and online newspaper reports in English and nine regional languages to identify relevant CRS reports. RESULTS: A total of 151 CRS reports were retrieved. CRS was more frequently reported among males (80.8%), those whose COVID status was unknown (48.0%), and those in quarantine/isolation (49.0%). CONCLUSION: The above findings may assist identification of at-risk individuals for COVID-19 related suicidal behavior.

Beliefs related to sexual intimacy, pregnancy and breastfeeding in the public during COVID-19 era: a web-based survey from India.

AIM: To evaluate the beliefs held by the public regarding sexual health, pregnancy, and breastfeeding during COVID-19 era. METHODS: It was an online cross-sectional survey conducted through the Survey Monkey® platform and after proper ethical approval a self-designed questionnaire was circulated by the snowballing sampling technique through the Whatsapp platform. RESULTS: 1636 people respondent to the survey questionnaire. 63% of the participants mentioned that kissing could spread nCoV-SARS. Unprotected sexual intercourse with the spouse can cause infection spread, was reported by about one-third (35.9%). Nearly one-fifth (22%) thought that unprotected sexual intercourse with unknown partners/persons could not spread the infection. About half (49.7%) of the participants reported COVID-19 infection can be transmitted from mother to the child/fetus during the process of birth or during pregnancy and one-fifth (21.3%) of the participants reported going ahead with the Cesarean section if the mother is suspected of having or is confirmed to have COVID-19 infection. About one-fifth feared for risk of birth defects and abortion in case the mother is infected with COVID-19. 28% of the participants reported COVID-19 infection can be transmitted to newborn by breastfeeding. CONCLUSIONS: The present study suggests that a significant proportion of people have misinformation about sexual intimacy, pregnancy, and breastfeeding in the ongoing pandemic which needs to be addressed.