Retinal Nerve Fiber Layer Thickness in Patients with Schizophrenia and Its Relation with Cognitive Impairment.

Background: Schizophrenia is a chronic severe mental illness with heterogeneous clinical presentation, course, and outcome. Cognitive impairment is one of its core features. Retinal nerve fiber layer (RNFL) imaging using OCT (optical coherence tomography) could provide easy access for in vivo imaging of the retina, rendering it as a "window to the brain." Studies done on schizophrenia have shown RNFL thinning. This study attempts to look into the association between cognitive impairment, disease duration, and RNFL abnormality in patients with schizophrenia using OCT. Methods: Patients diagnosed with schizophrenia meeting DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) criteria and who were confirmed to be in remission for at least six months clinically and scoring less than three on PANSS-8 (positive and negative symptom scale-8) remission scale were included. They were administered the Montreal Cognitive Assessment Scale (MoCA) for cognitive assessment. RNFL measures were taken using spectral domain-OCT. Variables were compared using Pearson's correlation test, one-way ANOVA test, and independent t-test as appropriate. Results: A total of 36 patients were studied. MoCA scores and RNFL thickness showed a positive correlation. Patients with schizophrenia had reduced average RNFL thickness and reduced RNFL thickness in superior, inferior, and temporal quadrants. Average RNFL thickness, Superior and inferior quadrant RNFL thickness showed a positive correlation with MoCA scores. No correlation was obtained between macular volume, macular thickness, duration of illness, and MoCA scores. Conclusion: Patients with schizophrenia have reduced average RNFL thickness. Patients with low MoCA scores have RNFL thinning.

The Sociodemographic Profile of Community-Dwelling Older Adults With Serious Mental Illness in Kerala - A Cross-Sectional Study.

Background: Older adults with serious mental illness (OASMI) have to manage the twin challenges of old age and mental illness. Understanding their characteristics will help policymakers and researchers plan tailored interventions. The profile of OASMI is not described in any publication from India, and this paper addresses that gap. The information from this study will serve as a baseline for the planned periodic follow-up of the study participants. Methods: This study employed a cross- sectional design among a sample of OASMI identified through multistage cluster sampling from three districts in Kerala. We interviewed them in their households and collected sociodemographic data using a pretested tool. Results: Among the 917 OASMI participants, 66% were females, 18% were the 'oldest-old' (≥80 years), 94.1% were unemployed, 51.7% were socially backward, 68.5% were financially weak, 10.1% were living alone, 59.4% were living without partners, and 63.7% had caregivers. Conclusion: Compared to the general population of older adults in Kerala, the OASMI have poorer socioeconomic status and higher rates of social isolation, and males are dying earlier. The profile of the OASMI depicts their multiple vulnerabilities and the need to address those.

Need for social work interventions in the emergency department.

This paper reports findings from a qualitative study conducted on the Need for Social work interventions in the Emergency Department (ED) at a large tertiary care center in India. The emergency department is an important social work intervention point for individuals with various psychiatric, medical, and social needs who have little or no additional interaction with social services. Social workers are specially trained to understand the impact of social factors on health outcomes and provide interventions that address social barriers to improving health and accessing community resources; social workers are well prepared to provide services in the emergency department. However, limited research is available to understand the impact of psychosocial services in the emergency department. We aimed to identify areas which require integrated social work services and coordination to address the psychosocial issues within the ED. Interviews with 10 healthcare workers are analyzed thematically. Recurring themes throughout the interviews confirm the need for providing social work interventions to ensure the medical, psychological, and social care needs in the emergency department.

Domestic violence and psychological problems in married women during COVID-19 pandemic and lockdown: A community-based survey.

BACKGROUND: Following the declaration of Coronavirus disease-2019 as a pandemic, a nation-wide lockdown was announced in India. This led to increase in psychological problems, especially in women. OBJECTIVES: To assess the prevalence of psychological problems and domestic violence (DV) in married women during the pandemic and lockdown in a panchayat in Southern India and to study the association of socio-demographic and clinical variables with psychological problems. MATERIALS AND METHODS: A cross-sectional study was undertaken in 209 married women of 18-55 years residing in a village panchayat of northern Kerala, India. Socio-demographic variables and clinical variables, like depressive symptoms, anxiety symptoms, perceived stress and DV, among others, were evaluated. The participants were interviewed by trained community health workers in the post-lockdown period. RESULTS: The prevalence of depressive symptoms was found to be 10.0 %, anxiety symptoms 7.2 % and perceived stress 66.0 %. Severe DV was reported by 6.2 %; but at least one form of DV was experienced by 25.8 % of the women. Significant positive correlation was observed for DV with depression and anxiety. DV was also found to be a significant predictor of depression (adjusted OR [aOR] = 4.26, P = 0.006) and anxiety (aOR=4.34, P=0.02). Being a homemaker (aOR=4.51, P = 0.03) and having past history of mental illness (aOR=5.39, P = 0.03) were also found to increase the risk for depression significantly. CONCLUSION: There is a high prevalence of psychological problems in married women during the pandemic and lockdown. DV was found to be a significant predictor of depression and anxiety in this population.

Psychosocial Effects of Isolation on Nipah Virus Infection Suspects during an Outbreak.

BACKGROUND AND METHODOLOGY: Nipah Virus (NiV) belonging to the genus Henipavirus is a biosafety level 4 pathogen with high human to human transmission. Nipah Virus outbreak of 2018 in Kozhikode, Kerala has evoked immense panic and fear in the system. Other viral infections with similar transmission pattern (Ebola, SARS, MERS or COVID 19) also identified with the negative impacts of isolation. This retrospective observational study was planned during November -December 2018 to understand the psychosocial effects among the subjects in Nipah isolation facility. The symptoms of Post-traumatic stress disorder (PTSD) were assessed using the Impact of Events Scale-Revised version (IES-R). RESULTS AND CONCLUSIONS: Of the 81 subjects, 73 could be contacted with a response rate of 90.12%. The mean age was 38 years (SD = 15.43) and 13.7% were health care workers. 63% of the subjects experienced fear of death during isolation stay and 12.3% of the subjects had lost their relatives or friends to Nipah infection. The mean IES score obtained was 10.78 (SD: 9.679, range 0-49) and 5 subjects had above the cut off 22. Nipah outbreak had evoked significant psychological disturbances in subjects who remained in isolation with its negative impacts.

Pattern and Correlates of Depression among Medical Students: An 18.Month Follow-Up Study.

BACKGROUND: Medical students are subjected to various challenges, which are possibly etiological in the onset and persistence of depression. There is inadequate research on the longitudinal pattern and correlates of the emotional health of medical students in India. We aim to delineate the longitudinal pattern of depression among medical students and the factors predictive of depression. METHODS: An 18-month follow-up design with 350 students (2012 intake) from two medical colleges in Kerala, India, was employed. A semistructured questionnaire and the Patient Health Questionnaire 9 were administered 2, 8, and 18 months into the course. RESULTS: Depression was present in 42.80%, 36.20%, and 42.50% of the students at the three assessments. Variables significantly associated with depression on univariate analysis were the course not being of the student's choice at the first assessment; having an unemployed parent (mother) at the second assessment; alcohol use and male gender at the third assessment. On multivariate analysis, male gender (OR = 1.95[1.11-3.41]) and the presence of depression at 2 months (OR = 2.30[1.31-4.05]) and 8 months (OR = 2.48[1.39-4.44]) were predictive of depression at 18 months. CONCLUSIONS: The high rates of depression and the pattern of high rates early in the course among the medical students contrasts with that reported from other countries. Early depression and male gender were predictive of depression later in the course. The implications of this are to be taken into consideration when undergraduate intervention programs are planned.

The Research Protocol of SENIOR Project-Psychiatric Services and Support System for Serious Mental Illness in Old Age, Kerala, India.

BACKGROUND: India has the second-largest population of elderly in the world. Serious mental illness (SMI) is a subset of the mental disorders that result in significant functional impairment and is usually long term. Persons with SMI face several challenges in their old age that are different from the issues faced by younger people with SMI. Understanding the problems faced by elderly individuals suffering from SMI is fundamental for planning programs to address them. The SENIOR (Support Systems Evaluation of Neuropsychiatric Illness in Old age) project is a study aimed at evaluating the problems faced in obtaining mental health care by elderly persons having SMI in the Kerala state of India. AIM: To describe the scientific methodology of the SENIOR project. METHODS: This study employs mixed-methods cross-sectional design among a minimum sample of 768 SMI patients identified through cluster sampling from three districts, and Focus Group Discussion among mental health program officials. DISCUSSION: This paper presents a methodological model to assist researchers in future field epidemiological studies on mental illness. Assessing service needs and barriers to access for the most vulnerable among the mentally ill will help the policymakers make evidence-based decisions to improve their quality of life.

Antenatal Depression, Epigenetic Gestational Age, Childhood Psychiatric Symptoms, and the Need to Consider the Possible Effects of Unaccounted Confounders.

Suarez et al.1 examined associations among antenatal depression, epigenetic gestational age (EGA) as a novel biomarker, and early childhood psychiatric problems. They found that greater severity of antenatal depression predicted lower EGA and that lower EGA predicted total and internalizing problems at 3.7 years of age. Although they included many covariates in their analysis, we believe that the value of the study could have been enhanced by the inclusion of potentially important but unaddressed confounders.