Physical Activity of School-Going Adolescents During the COVID-19 Pandemic: A Natural Experiment Study.

OBJECTIVE: To assess the impact of the COVID-19 pandemic associated governmental restrictions on physical activity and sedentary behavior of school-going adolescents in India and its effect on nutrition and health status. METHODS: This was a before-after natural experiment study that recorded paired data of 449 (206 boys) school-going adolescents. COVID-19 related governmental measures (March 24, 2020 till February 2021) were taken as the natural experiment. The change in proportion of adolescents who met the recommended amount of physical activity guidelines and change in sedentary and dietary behaviors and body mass index (BMI) were compared. RESULTS: The proportion of adolescents performing adequate physical activity decreased from 33.9% to 30.7% (OR 1.2,95% CI 0.9,1.6) during the pandemic. Fruit intake increased by 8.1% during the pandemic while junk food intake decreased by 17% during the pandemic. Mean (SD) BMI z-scores increased from -0.7 )1.4) to -0.5 )1.3) (P < 0.001). CONCLUSION: While there was a small decrease in the proportion of physically active adolescents during the pandemic, a shift towards healthier dietary habits was seen.

Translation and Validation of Hindi Version of Adolescent Peer Relation Instrument for Bullying Victimization.

OBJECTIVES: To translate and validate Hindi version of Adolescent Peer Relation Instrument (APRI) and to evaluate burden of bullying victimization among school-going adolescents. METHODS: A school-based cross-sectional study was performed from July 2021 to June 2022 on 9th-12thclass students. Adolescent peer relation instrument was used to evaluate bullying victimization. Reliability and validity of tool, prevalence and strength of association was analyzed by appropriate statistical methods. RESULTS: Bullying and victimization were present in 70.8% and 62.9% adolescents, respectively. Total bullying was significantly less in students <16 years of age (OR 0.995, 95% CI 0.483, 2.049) and those with less than three friends (OR 0.816, 95% CI 0.482, 1.383). Total bullying and total victimization was significantly more in boys (OR 1.993, 95% CI 1.281, 3.099 for bullying and OR 1.584, 95% CI 1.047, 2.397 for victimization). Cronbach's alpha for bullying and victimization was 0.89 and 0.897, respectively. Convergent validity between items of different subscales of bullying and victimization was observed (r value > 0.7) except for social bullying and social victimization. There was weak correlation between subscales of bullying and victimization suggestive of discriminant validity (r value < 0.4). CONCLUSIONS: The Hindi version of APRI has a good reliability and construct validity. About three-fourths and two-thirds of adolescents were involved in bullying and victimization, respectively, with a few identified risk factors. Special counselling sessions at schools must be implemented for children involved in bullying.

Learning Preference of Medical Undergraduate Students: A Multi-Institutional Survey.

This cross-sectional multi-institutional study was conducted to analyze learning preference among medical undergraduate students (n=1659) in four colleges in Haryana. VARK questionnaire (v8.01) was administered through designated study leaders of the respective institutes. The most preferred learning modality was kinesthetic (21.7%), which favors experiential form of learning, most suited for teaching-learning of skills in medical curriculum. More information on the learning preference of medical students is needed to optimize learning outcomes.

Mini-Clinical Evaluation Exercise as a Tool for Formative Assessment of Postgraduates in Psychiatry.

CONTEXT: Introduction of competency-based medical education in India has necessitated a diversion from traditional methods of teaching and assessment. AIM: The aim of this study was to assess the feasibility and acceptability of mini-clinical evaluation exercise (mini-CEX) as a tool for formative assessment of postgraduates in psychiatry at our institute. SETTINGS AND DESIGN: It was a prospective, quasi-experimental study carried out in the Department of Psychiatry, PGIMS, Rohtak (India). MATERIALS AND METHODS: After obtaining written informed consent, trainees (18) were sensitized and faculty members (5) were trained to use mini-CEX and regarding the feedback process with the help of workshops. STATISTICAL ANALYSIS USED: Data collected were analyzed using descriptive statistics. Mean differences between the sessions were assessed using a paired sample t-test. P < 0.05 was considered as level of significance. RESULTS: Statistically significant difference was found between session 1 and session 6 for counseling skills but not for three sessions of diagnostic skills. Mini-CEX was accepted as a better learning method by 61% of the postgraduates, 36% felt that it improved their clinical skills, 64% reported a boost in their confidence, and 89% looked forward to these encounters. Majority of the postgraduates and faculty members suggested that the mini-CEX should be regularly used in academic settings and should be introduced early in the training. CONCLUSIONS: Mini-CEX is a feasible formative assessment tool for postgraduates in psychiatry and an effective method of learning by the postgraduates, inducing a significant improvement in the counseling skills of students. Teaching faculty also accepted mini-CEX as an effective method of formative assessment.

Oral health perception and plight of patients of schizophrenia.

OBJECTIVE: To assess the oral health status, perception and dental treatment needs in patients of schizophrenia in the hospital set-up in Rohtak district, Haryana. METHODS AND RESULT: A cross-sectional study was conducted to assess the oral health in patients of schizophrenia at Postgraduate Institute of Medical Sciences, Rohtak, Haryana amongst patients with ≤48 score on BPRS. A modified Dental Coping Belief Scale along with a structured questionnaire and clinical examination were recorded. Descriptive and inferential statistics were used in relation to demographic variables. Amongst 111 subjects, 74.4% were males and the mean age was 34.73 ± 9.9 years. Around 77.5% had habit of regular mouth rinsing, 72% and 3% brushed their teeth once and twice daily, respectively. Subjects had high negative oral health beliefs and external locus of control for oral health. Compared to the general population, mean OHI (8.4 ± 2.5) and DMFT (3.09 ± 2.9) scores were higher. Nearly, 66% patients had gingival pockets and around 7% showed attachment loss above 3 mm or gingival recession. CONCLUSION: Patients with schizophrenia have much poorer oral health as compared to general population. They are aware of their poor oral hygiene but are not motivated enough to take care of their oral health. A multifaceted approach is required to plan and undertake effective oral health preventive and rehabilitative measures for this special group.

Help-seeking behaviors for mental health problems in medical students: Studies in Thailand and India.

OBJECTIVES: To compare the rate of help-seeking from mental health professionals (MHPs) and other sources of help for mental health problems of medical students in Thailand and India, and explore factors associated with help-seeking from MHPs. METHODS: Cross-sectional survey-based study was conducted in two medical schools in Thailand and India. Students were asked to rate their preferences for each source of help on a Likert-scale basis. Mental health status was measured by the General health questionnaire-12 (GHQ-12). Attitudes and stigma toward mental illness were collected using the Mental illness clinician's attitude scale: medical student version or MICA v2. RESULTS: 593 students participated in the survey. The percentage of students who chose to seek help from any source was lower in Thailand than in India. 81 % of students in India site chose to seek help from MHPs, compared to 66 % in Thailand site. The risk factors for avoiding seeking help from MHPs in Thailand were history of alcohol use (OR = 1.88, p = .014) and total GHQ score (OR = 1.11, p = .006), whereas having GHQ score ≥ 2 was a significant risk factor in India (OR = 2.20, p = .044). Total MICA score, which reflected overall attitude toward mental illness, was not associated with seeking help from MHPs. CONCLUSIONS: The rate of help-seeking behaviors for mental health problems and factors associated differed between medical students in Thailand and India. A high GHQ score was a common risk factor of not seeking help from MHPs in both countries.

Effectiveness of oral health education on oral hygiene status among schizophrenic patients: A randomized controlled study.

AIM: The study aims to assess the effectiveness of oral health education on oral hygiene status among schizophrenic patients. METHODS AND RESULTS: A randomized parallel controlled trial was conducted among schizophrenic patients (n = 111) with BPR score of ≤ 48 to assess the role of oral health education on their oral hygiene status. The experimental group (n = 56) received oral health education while the control group (n = 55) were administered standard care advice. Reinforcement in the form of printed calendar was done after 1 month followed by final assessment of KAP (knowledge, attitude and practice) through DCBS (Dental Coping Beliefs Scale), while oral hygiene through the oral hygiene index done after 2 months. Majority of subjects were males with mean age of 34.73 ± 9.9 years and mean duration of illness of 6.41 ± 5.2 years. All domains of the modified DCBS showed significant improvement in the experimental group. Frequency of brushing twice a day increased from 5.4% to 23.2% (p < 0.05) in the experimental group. DI score was 2.28 ± 0.93 versus 2.98 ± 1.3 (p < 0.02) in the experimental group as compared to the control group. CONCLUSION: The oral health education with reinforcement in the form of printed calendar although showed statistically significant changes but lacked clinical importance.

Undergraduate psychiatry in India: A SWOT analysis.

Psychiatric disorders are highly prevalent and remains a huge burden on the society. In spite of that persons with mental illness are marginalized and mental health is largely being neglected. There is an acute shortage of mental health professionals in India, and also there is inadequate exposure to psychiatry during the medical undergraduate training in India. Moreover, the perception towards psychiatry and psychiatrists is not favorable among medical fraternity and policy makers. This is reflected in the fact that in spite of clearly deficient undergraduate psychiatry curriculum, no steps have been taken towards improving it and recommendations are not being implemented in true spirit. This review tries to identify the gaps in undergraduate curriculum, present a SWOT analysis of current situation and recommend the possible ways to address the deficiencies particularly in India.

A Comparative Study of Trigger Point Therapy with Local Anaesthetic (0.5 % Bupivacaine) Versus Combined Trigger Point Injection Therapy and Levosulpiride in the Management of Myofascial Pain Syndrome in the Orofacial Region.

AIM: To compare the efficacy of combined local anesthetic injection with 0.5 % bupivacaine and levosulpiride versus local anesthetic injection alone on outcome measures including levels of pain intensity and depression in the management of myofascial pain syndrome in orofacial region. PATIENTS AND METHODS: This was a prospective, randomized, controlled and open-label comparative clinical study. Seventy-four patients diagnosed to have myofascial pain syndrome and fulfilling the inclusion criteria were enrolled for the study. Patients were randomly assigned into 2 groups. Group A received local anesthetic injection (0.5 % bupivacaine) on trigger points and Group B received combined trigger point injection therapy and 50 mg of tablet Levosulpiride orally B.I.D. They were assessed for pain intensity and depression at baseline and at follow-up of 1, 4, 6 and 12 week intervals. RESULTS: The mean age of patients was 44.54 + 15.977 years in group A and 39.97 + 14.107 years in group B (P value = 0.2). Group A comprised of 25 females (67.567 %) and 12 males (32.432 %) while group B had 27 females (75 %) and 9 males (25 %). 70.27 % were diagnosed with moderate depression in group A and 75 % in group B. 18.91 % in group A and 19.44 % in group B were diagnosed with severe depression. When the VAS score and BDI score was compared at the follow-up intervals with the baseline scores in both treatment groups, the mean difference was highly significant at all the follow-up intervals. However when the relative efficacies of two interventions were compared between the two groups, improvement in pain was significant at all the follow-up intervals except the 1st week follow-up whereas the improvement in depression was non-significant at 1st and 4th week interval while it was highly significant at 6th and 12th week intervals. CONCLUSION: The combined therapy with trigger point injection and levosulpiride as antidepressant significantly reduces pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.

Indian psychiatric society multicentric study: Correlates of prescription patterns of psychotropics in India.

BACKGROUND: There is a lack of information on the clinical and sociodemographic correlates of prescription of psychotropics by psychiatrists. AIM AND OBJECTIVE: This study aimed to evaluate the relationship of prescription patterns with various clinical and sociodemographic variables. METHODOLOGY: Data of prescription patterns, psychiatric diagnosis, sociodemographic variables, and comorbid physical illnesses were collected for 4480 patients, across 11 centers. RESULTS: Females are more often prescribed escitalopram, sertraline, amitriptyline, amisulpride, nonlithium mood stabilizers, and benzodiazepines, whereas males are more often prescribed fluoxetine, olanzapine, two antipsychotics concurrently, typical antipsychotics, valproate, lithium, and more than one benzodiazepine. Elderly (>65 years) participants are more often prescribed sertraline when compared to adolescents. In addition, elderly more often receive quetiapine and less often are prescribed benzodiazepines. Those with comorbid neurological disorders are commonly prescribed antipsychotics, amitriptyline, and more than one antidepressant and are less commonly prescribed lithium, combination of two mood stabilizers, and benzodiazepines. Those with cardiac ailments are more commonly prescribed sertraline, quetiapine, and lithium and less frequently prescribed amitriptyline, fluoxetine, olanzapine, risperidone, and typical antipsychotics. Those with diabetes mellitus more often received escitalopram and quetiapine. Presence of more than one psychiatric diagnosis was associated with the use of more number of medications. Further, diagnosis of affective disorders was associated with the use of a higher number of medications. CONCLUSION: Findings of the present study suggest that sociodemographic variables and physical and psychiatric comorbidity influence the prescription patterns of psychotropics.

Indian Psychiatric Society multicentric study: Prescription patterns of psychotropics in India.

BACKGROUND: There is a lack of national level data from India on prescription of psychotropics by psychiatrists. AIM AND OBJECTIVE: This study aimed to assess the first prescription handed over to the psychiatrically ill patients whenever they contact a psychiatrist. MATERIALS AND METHODS: Data were collected across 11 centers. Psychiatric diagnosis was made as per the International Classification of Diseases Classification of Mental and Behavioural Disorders 10(th) edition criteria based on Mini International Neuropsychiatric Interview, and the data of psychotropic prescriptions was collected. RESULTS: Study included 4480 patients, slightly more than half of the subjects were of male (54.8%) and most of the participants were married (71.8%). Half of the participants were from the urban background, and about half (46.9%) were educated up to or beyond high school. The most common diagnostic category was that of affective disorders (54.3%), followed by Neurotic, stress-related and somatoform disorders (22.2%) and psychotic disorders (19.1%). Other diagnostic categories formed a very small proportion of the study participants. Among the antidepressants, most commonly prescribed antidepressant included escitalopram followed by sertraline. Escitalopram was the most common antidepressant across 7 out of 11 centers and second most common in three centers. Among the antipsychotics, the most commonly prescribed antipsychotic was olanzapine followed by risperidone. Olanzapine was the most commonly prescribed antipsychotic across 6 out of 11 centers and second most common antipsychotic across rest of the centers. Among the mood stabilizers valproate was prescribed more often, and it was the most commonly prescribed mood stabilizer in 8 out of 11 centers. Clonazepam was prescribed as anxiolytic about 5 times more commonly than lorazepam. Clonazepam was the most common benzodiazepine prescribed in 6 out of the 11 centers. Rate of polypharmacy was low. CONCLUSION: Escitalopram is the most commonly prescribed antidepressant, olanzapine is the most commonly prescribed antipsychotic and clonazepam is most commonly prescribed benzodiazepine. There are very few variations in prescription patterns across various centers.

A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region.

PURPOSE: To evaluate the effect of therapy with levosulpride combined with conventional trigger point injection therapy in terms of pain and depression in the chronic myofascial pain syndrome patients. MATERIALS AND METHODS: This was a comparative prospective study in which subjects with at least one trigger point and symptom duration of at least 3 months were recruited and randomized into two groups. Group A subjects received trigger point injections with 0.5 % bupivacaine and tablet levosulpride and group B received trigger point injections and a placebo. Subjects were assessed for pain with visual analog scale (VAS) and depression with Beck's depression inventory (BDI) at the follow-up periods of 1, 4, 6 and 12 weeks. The treatment effect was measured in terms of mean difference of BDI and VAS scores at various studied intervals from the baseline values. RESULTS: The sample was composed of 15 subjects with 8 in group A (6 females and 2 males, with a mean age of 41.88 ± 15.13 years, disease duration of 12.37 ± 16.11 months) and 7 in group B (6 females and 1 male, with a mean age of 43.86 ± 12.34 years, disease duration of 9.64 ± 9.34 months). The mean baseline VAS score and BDI score was 6.75 ± 1.03 in group A and 6.86 ± 1.06 in group B and 24.25 ± 10.20 in group A and 24.43 ± 11.16 in group B respectively. The mean difference of VAS scores at 12th week interval from the baseline values was highly significant. Although the mean difference of VAS scores at all the other intervals and mean difference of BDI scores at all the intervals was statistically nonsignificant, there was improvement in the mean differences at all the follow-up intervals in terms of both pain as well as depression. CONCLUSIONS: The combined therapy with conventional trigger point injection and levosulpride as antidepressant significantly reduce pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.

Dose-dependent galactorrhea with quetiapine.

Quetiapine is an atypical antipsychotic agent with minimal propensity to induce hyperprolactinemia in standard therapeutic dosages. Despite that quetiapine is considered to be a prolactin-sparing atypical antipsychotic, hyperprolactinemia with related side effects may rarely be encountered in susceptible individuals. We report a case of quetiapine-induced hyperprolactinemia and galactorrhea in an adult female, which was dose-dependent.

Clozapine in pregnancy.

This report describes the case of a woman with treatment-resistant schizophrenia who became pregnant while being treated successfully with clozapine. Possible risks associated with continuation of clozapine during pregnancy are discussed.