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Schizophrenia in children is diagnosed by using adult criteria. Based on the age of onset, patients with childhood onset schizophrenia (COS) are subdivided into those with very early onset (before age 12-14 years) and those with early onset (between 14-17 years). The prevalence of COS is reported to be 1 in 10,000 before the age of 12 years; however, there is a significant increase around puberty and early adolescence and by 18 years of age, 20% of the patients with schizophrenia will have the illness. Simple delusions and hallucinations revolving around childhood themes, language and communication deficits and flat affect have been reported in COS. Follow-up studies suggest that the outcome is generally poor to fair. Predictors of poor outcome are age of onset (less than 12 years), insidious onset and marked premorbid abnormalities. (Contains 1 table.)

BACKGROUND: Brain-derived neurotrophic factor (BDNF) has considerable relevance in neural growth and differentiation. It has been evaluated as a biomarker for individuals with various psychiatric disorders such as substance-related disorders and psychotic disorders. OBJECTIVE: The present study explored differences in the levels of BDNF (in serum) among subjects using cannabis (with and without schizophrenia). METHODS: This cross-sectional observational study compared the serum BDNF level in male subjects aged 18-45 years. Four groups of 20 subjects each were included: individuals with tobacco use disorder only, patients having schizophrenia, patients with cannabis use disorder, and finally patients with comorbid cannabis use disorder and schizophrenia. RESULTS: The BDNF levels were found to be significantly different across the four groups. The BDNF levels in subjects with concurrent schizophrenia and cannabis use disorder were higher than each of the other three groups (cannabis use disorder, schizophrenia, and tobacco use disorder only). CONCLUSION: We find that BDNF may be higher when cannabis use disorder and schizophrenia co-occur, as compared to either of the conditions alone. The findings should be interpreted with caution due to the low sample size and potential confounders. [ABSTRACT FROM AUTHOR]

Background and Aims: There is limited research on the impact of COVID-19 pandemic on caregivers of patients with severe mental illness (SMI) during its late phase when sufficient and widespread knowledge about management and preventive aspects existed. We aimed to assess the impact of COVID-19 pandemic on caregivers of patients with SMI during Omicron wave. Methodology: We assessed 100 caregivers of patients with preexisting SMI diagnosed on the Diagnostic and Statistical Manual of Mental Disorders-5, 50 each of schizophrenia and related psychotic disorders (SCZ) and bipolar disorder (BD) from December 14, 2021, to February 9, 2022. We assessed symptoms of depression, anxiety, stress, and family burden in caregivers and their coping strategies by the Depression, Anxiety, and Stress Scale-21 Hindi version, Family Burden Interview Schedule (FBIS), and Brief-Coping Orientation to Problem Experienced, respectively. Results: Caregivers of SMI experienced symptoms of depression (51%), anxiety (72%), and stress (13%), with significantly more symptoms of depression (P = 0.002) and anxiety (P = 0.025) in caregivers of SCZ. High caregiver burden (score: 25.76, > half of the total score on FBIS) was found with no significant difference in the two groups. Caregivers of SCZ used a greater number of emotion-focused coping strategies, whereas those with BD used more problem-focused coping, but the difference was not significant. A significant association was seen between coping strategies of substance use and depressed symptoms (P = 0.003), substance use and anxiety symptoms (P = 0.007); anxiety symptoms with denial (P = 0.001) anxiety symptoms and venting (P = 0.008) in caregivers of BD. Conclusion: Caregivers of patients with preexisting SMI experienced depression, anxiety, and high family burden during Omicron wave. They used both emotion- and problem-focused coping strategies. [ABSTRACT FROM AUTHOR]

Background The clinical heterogeneity in major depressive disorder (MDD), variable treatment response, and conflicting findings limit the ability of genomics toward the discovery of evidence-based diagnosis and treatment regimen. This study attempts to curate all genetic association findings to evaluate potential variants for clinical translation. Methods We systematically reviewed all candidates and genome-wide association studies for both MDD susceptibility and antidepressant response, independently, using MEDLINE, particularly to identify replicated findings. These variants were evaluated for functional consequences using different in silico tools and further estimated their diagnostic predictability by calculating positive predictive values. Results A total of 217 significantly associated studies comprising 1200 variants across 545 genes and 128 studies including 921 variants across 412 genes were included with MDD susceptibility and antidepressant response, respectively. Although the majority of associations were confirmed by a single study, we identified 31 and 18 replicated variants (in at least 2 studies) for MDD and antidepressant response. Functional annotation of these 31 variants predicted 20% coding variants as deleterious/damaging and 80.6% variants with regulatory effect. Similarly, the response-related 18 variants revealed 25% coding variant as damaging and 88.2% with substantial regulatory potential. Finally, we could calculate the diagnostic predictability of 19 and 5 variants whose positive predictive values ranges from 0.49 to 0.66 for MDD and 0.36 to 0.66 for response. Conclusions The replicated variants presented in our data are promising for disease diagnosis and improved response outcomes. Although these quantitative assessment measures are solely directive of available observational evidence, robust homogenous validation studies are required to strengthen these variants for molecular diagnostic application. [ABSTRACT FROM AUTHOR]

Summary: This paper presents a fractal‐based compact new monopole antenna for wideband applications. The miniaturization has been achieved by incorporating Minkowski and Koch‐snowflake fractals. The proposed antenna design is etched on top of Rogers RT/5880 dielectric material with a dimension of 8.10×8.10 mm2. The antenna is designed, analyzed, fabricated, and tested in the laboratory. The proposed geometry operates over a 8.62–22.40 GHz with fractional bandwidth (FBW) of 88.84% and VSWR is less than 2. The proposed monopole antenna exhibits nearly omnidirectional radiation patterns over the entire resonating band with a gain of 1–2.91 dBi and a radiation efficiency of more than 60.5%. Also, the measured results of the prototype make an excellent agreement with the simulated counterpart. Further, the antenna gives good time‐domain characteristics. Therefore, the proposed miniaturized antenna can be used in X/Ku/K‐band applications. [ABSTRACT FROM AUTHOR]

Background and Aims: There is lack of research on somatic symptoms in schizophrenia. We aimed at finding prevalence and types of somatic symptoms in patients with schizophrenia and assessed their association with socio-demographic and clinical characteristics. Methods: We assessed somatic symptoms using Patient Health Questionnaire-15 (PHQ-15) in 93 patients with schizophrenia diagnosed on ICD10-DCR. Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms, WHO Disability Assessment Schedule 2.0, WHO Quality of Life (BREF) Hindi version and Liverpool University Neuroleptic Side-Effect Rating Scale were used to assess psychopathology, disability, quality of life and side effects. Results: Significant somatic symptoms (n ≥5 on PHQ-15) were present in 62 (67.7%) patients with schizophrenia. Forty three (69.4%) had mild (n = 5-9 on PHQ-15), 17 (27.4%) had moderate (n = 10-14 on PHQ-15), and only 2 (3.2%) had severe (n = ≥15 on PHQ -15) somatic symptoms. Mean somatic symptoms score on PHQ-15 was 7.28 (± 3.83); 96.8% reported feeling tired, 76.3% had constipation or diarrhoea, 67.7% trouble in sleeping, 61.3% nausea or indigestion, 52.7% back pain and 51.6% headache. Patients with somatic symptoms were older in age, had longer duration of illness and treatment, and had more negative symptoms. They had higher disability and poor quality of life especially in physical domain. Conclusion: Somatic symptoms are common in patients with schizophrenia and are associated with chronicity, refractoriness and negative symptoms, significant disability and poor quality of life. Thus during routine clinical practice, somatic symptoms should be assessed and managed in these patients. [ABSTRACT FROM AUTHOR]

Aims: To understand the current patterns and experience of using internet among individuals with severe mental disorders and assess the impact of internet technology in their daily life, particularly mental health-related issues. Methods: In-depth interviews were conducted on individuals diagnosed with bipolar disorder (BD)/schizophrenia (DSM-5) (N=20), aged = 18 years who could read and write in Hindi/English, using an interview guide. HAM-D, YMRS, SAPS, and SANS were used as screening instruments. The interview guide contained questions related to internet use in daily life, internet use for health-related issues, particularly BD/schizophrenia. Results: All individuals used the internet in day-to-day life for the purpose of communication, entertainment and getting information. They predominantly use internet to find out about their illness & medications. For their illness, most common source of searching was Google (N=20), followed by YouTube (N=17). Three themes could be identified about patterns and experience of internet use: health/illness-related reasons for searching internet, beliefs about the suggestions on internet, risky practices regarding suggestions from internet. The impact of internet use was variable. They often believed that they were misinformed or unsure of the information available online. Most of them did not discuss about their internet use for their disease with their treating doctor. But they tend to follow advice that they perceive might be harmless. Conclusion: Patients with SMD commonly use internet for retrieving information about their illness. They tend to follow perceivably harmless advice available online. [ABSTRACT FROM AUTHOR]

Background: The duration of untreated psychosis (DUP) impacts symptomatic and functional outcome in patients with psychosis. Objectives: This study assessed DUP, its association with sociodemographic and clinical factors and its impact on short-term clinical and functional outcome in patients with first episode psychosis. Methodology: Sixty-nine first contact patients with first episode psychosis who had not received adequate treatment for psychosis (adequate treatment - antipsychotic medication of =3.5 mg haloperidol equivalents for = 4 weeks) previously were assessed with Symptom Onset in Schizophrenia Inventory to determine DUP. They were followed up for 12 weeks. Positive and Negative Syndrome Scale and World Health Organization Disability Assessment Scale - II were used to assess symptoms and functioning at presentation and after 12 weeks. Results: The mean DUP for the sample (n=69) was 56.7 ± 89.1 weeks (13.2 ± 20.8 months). About three fifths (60.9%) of the subjects had DUP = 3 months (short DUP) and two fifths (39.1%) had DUP > 3 months (long DUP). Univariate analysis found age, employment, mode of onset and diagnosis to be significant. At followup, treatment-related improvement in positive, general and total symptom scores was significantly negatively correlated with DUP and improvement in functioning was significantly greater in patients with DUP < 3 months. A step-wise multiple logistic regression model identified mode of onset, age, and history of prior attempts at treatment as independent predictors of membership to the two DUP categories; insidious onset led to a 20-fold and a history of prior treatment attempts indicated a 400% increase in the odds of belonging to the long DUP category. An average of 9% increase in odds of having long DUP was observed with every one-year increase in age. Conclusion: Early detection (short DUP) of psychosis was found to have a salutary impact on clinical and functional outcome. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To assess the current patterns and experience of internet use among persons with depressive and anxiety disorders, particularly for health-related issues. Methodology: In-depth interviews were conducted with persons diagnosed with depressive and anxiety disorders (DSM-5), aged ≥18 years who could read and write in Hindi/English, using an interview guide. The interview guide contained questions related to internet use in daily life, internet use for health-related issues, and internet use for stress, and internet use for anxiety/depressive disorder. Interview data were transcribed and analyzed to identify codes and subsequently themes. Results: A total of 20 subjects; 10 each diagnosed with depressive and anxiety disorders were interviewed. About half the participants could operate internet independently, while rest required assistance. YouTube was the most common search engine used, and leisure was the most common reason for daily use. Almost all participants reported searching internet for health-related information including their psychiatric diagnosis. The most common purpose, for health in-general, was searching for alternate therapies. Most common purpose for psychiatric diagnosis was understanding the symptoms, recovery from their illness, and side effects of medicines. Highest impact as perceived by the participants was on distraction or stress reduction rather than direct impact on the illness/treatment. Conclusion: Persons with depressive and anxiety disorders use internet for distraction, communication, and seeking information about the illness and medicines. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) pandemic has impacted persons with preexisting psychiatric disorders negatively. There is a lack of studies on the impact on people with preexisting psychotic disorder. Aims: We studied the impact of the COVID-19 pandemic and lockdown on patients with a preexisting psychotic disorder and whether they were following the recommended preventive measures for COVID-19. We also studied coping strategies used by them and their caregivers. We compared persons with first-episode psychosis (FEP) and chronic psychotic disorders (CPD). Methodology: The study sample was a part of the National Institute of Health Research Psychosis Research Group cohort. The subjects belonged to two groups: FEP consisted of patients with the first episode of psychosis, with the duration of illness ≥3 months and ≤2 years, and CPD group consisted of patients with psychosis, with the duration of illness ≥2 years. They were interviewed telephonically on a semistructured questionnaire. Thematic analysis was done to identify coping strategies. Results: Fifty patients were interviewed: 24 in the FEP (26·12 ± 8·0 years) and 26 in the CPD group (34 ± 7.5 years). Forty-six (92%) patients reported difficulty in access to hospitals and 32 (64%) had difficulty in contacting a doctor. Eight (16%) of them reported worsening of symptoms and 12 (24%) reported irregular adherence to treatment. The two groups differed significantly on doing household chores, occupational functioning, and financial issues. The majority of them used emotion-focused coping strategies. Three-fourth (79.1%) of the patients in the FEP group were following all four recommended preventive measures, whereas, in the CPD group, three-fourths (73.1%) were able to follow only one measure. Conclusion: The COVID-19 pandemic had impacted FEP and CPD groups differently. CPD group could follow recommended preventive measures less frequently than FEP. [ABSTRACT FROM AUTHOR]

Serotonin‐dopamine activity modulators (SDAMs) have been approved as an adjunctive treatment to antidepressants in patients with inadequate response. These drugs have been proposed to have a beneficial effect on cognition, sleep‐related problems, and other affective symptoms in patients with depression. Previous studies have shown inconsistent evidence and have not reported a pooled effect of the 2 drugs of this class: aripiprazole and brexpiprazole. This meta‐analysis evaluated the effect of augmentation with SDAM drugs in patients with major depression. The meta‐analysis protocol was made as per Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Protocol guidelines and registered in the International Prospective Register of Ongoing Systematic Reviews. The PubMed/MEDLINE, Cochrane Clinical Trial registry, and EudraCT databases were searched with prespecified search terms. A random‐effects meta‐analysis was performed using the meta package in R software. Fifteen studies were included in this meta‐analysis. The random‐effects model analysis observed a pooled effect of 1.55 (95%CI, 1.32‐1.84; prediction interval, 0.95‐2.55, z = 5.19 [P <.0001]) for remission between the SDAM and placebo groups. A pooled effect of 1.58 (95%CI, 1.37‐1.83; prediction interval, 1.00–2.51, z = 6.34 [P <.0001]) for adverse events and 0.72 (95%CI, 0.48‐1.08; prediction interval, 0.46‐1.12; z = −1.58 [P =.113]) for serious adverse events was observed. No significant publication bias was noticed. The quality of the evidence was rated as high. Adjunct SDAM increased remission in patients and had no significant effect on serious adverse events compared to placebo. Therefore, we conclude that SDAM drugs can be an effective and safe antidepressant augmentation strategy in patients with major depressive disorder. [ABSTRACT FROM AUTHOR]

Background: We aimed to understand the needs of service users – families and patients with schizophrenia and related disorders, and mental health professionals (MHPs) and expectations from a home-based psychosocial intervention program in Indian setting. Materials and Methods: We conducted four focus group discussions (FGDs) with families, patients with schizophrenia and related disorders and MHPs. Two FGDs were conducted with families and one each with the patients and MHPs. Participants in families and MHP group were asked about their primary concerns in caring for the patients, perceived needs of patients and the areas that can be targeted through a home-based psychosocial intervention program. All FGDs were audio-recorded and verbatim transcribed. Content analysis of the data was done to obtain a final list of needs and expected outcomes from a psychosocial intervention supported by families. Results: Six key priority needs were identified for intervention: medication adherence, activities of daily living, promoting physical health, engagement in meaningful work, building of social and support networks and information about all aspects of illness. Priority outcomes identified by MHPs were mostly clinical like symptom reduction, fewer rehospitalisation while families and patients focused more on psychosocial outcomes, such as improvement of wellbeing, having relationships, engagement in meaningful activities, better organization of the day, increased self-respect, reduced stress, lesser interference, and critical comments. All groups suggested that book or mobile app or video could be used. Conclusion: This qualitative study shows that while both clinicians and service users consider recovery from schizophrenia and related disorders to be important, they differ on what they prioritise. [ABSTRACT FROM AUTHOR]

Byline: Garima. Shukla, Priya. Agarwal, Rajesh. Sagar, Mamta. Sood, Aditya. Gupta, Ashish. Suri, Ajay. Garg Surgery is an established and increasingly utilized treatment option in medically refractory temporal lobe epilepsy. [...]

Background: India has a large youth population whose mental health needs must be addressed. This includes promotion of positive mental health, with early detection and effective intervention for mental health disorders. Understanding the perspectives of community stakeholders working with youth is pivotal to this effort. Current study aimed to bring together a group of community stakeholders (eg, parents, teachers, policy makers) to understand their perspectives on youth mental health problems, challenges in provision of care, and to provide recommendations to address these concerns at national level. Materials and methods: The study was conducted across two sites in India: Chennai and New Delhi. Three group meetings were conducted involving 52 participants, including governmental, non‐governmental and community representatives working with youth. The proceedings were manually recorded, transcribed, and analyzed using thematic analysis method. Results: Many youth mental health problems were similar across the two sites. The commonest drivers of mental health problems were reported to be academic pressure, substance use and problematic internet/social media use. Stigma and lack of awareness were identified as the most important challenges acting as barriers to seeking mental health help by youth. Prioritizing youth mental health as a national programmes along with strong political will were the major recommendations suggested by the stakeholders. Conclusion: Initial findings suggest that prioritizing youth mental health programmes in India would be advantageous. Inclusive and collaborative approach, involving community stakeholders working with youth in providing services that promote mental health and early access to care will help in developing healthy young citizens. [ABSTRACT FROM AUTHOR]

Byline: Sagar. Bera, Sudhir. Khandelwal, Mamta. Sood, Vinay. Goyal Objectives: To compare psychiatric co-morbidity, quality of life and disability between patients of migraine and tension type headache and healthy controls. [...]

COVID-19 is an unprecedented event and has affected patients with psychiatric disorders in multiple ways. Patients in inpatient settings are at high risk of exposure of getting COVID-19 infection. We reviewed the literature on the inpatient psychiatric facilities and measures regarding how to address COVID-19 in these settings. We then provide an experiential narrative of the strategies and improvisations to meet the challenges of COVID-19 so as to continue the inpatient services at a large public funded medical school and hospital in North India. Literature suggested that it is important to restrict hospitalization, expedite discharges, prohibit visit of the attendants, minimize group activities, provide psychological assistance, multidisciplinary teams to provide care, to tackle issue of stigma, have adequate means for practicing preventive measures, creating facility for isolation and have clear guidelines for diagnostic testing. The psychiatry ward in our hospital was designated non-COVID ward and substantial beds were reserved for surgical trauma patients. For organizing inpatient services, we created a multidisciplinary team. Some of the measures were institute-mandated, while others were intra-departmental measures to protect staff as well as patients in the psychiatry ward. It can be concluded that COVID-19 pandemic is still an evolving situation. The measures to prevent exposure to COVID-19 infection in the inpatient facilities continues to evolve as and when fresh challenges emerge. [ABSTRACT FROM AUTHOR]

Byline: Bichitra. Patra, Sudhir. Khandelwal, Mamta. Sood An 18 year old male diagnosed as a case of bipolar affective disorder (BPAD), developed neuroleptic malignant syndrome (NMS) following treatment with olanzapine [...]

Background: Oral health during pregnancy plays a crucial role in the overall health and well-being of pregnant women. Evidence shows that most young children acquire cariogenic organisms from their mothers. Poor maternal knowledge about oral diseases combined with inappropriate feeding can lead to severe caries among young children. The aim of study was to assess the oral health status of pregnant women and to evaluate the gain in their knowledge after educational session in an antenatal setting.Materials and Methods: It is a pre- and post-intervention study carried out on the pregnant women (n = 198) attending an antenatal clinic in a tertiary care hospital. A specially designed semi-structured 14-point questionnaire was used to assess the pre- and post-knowledge and attitude to the oral health. Each participant was educated for self and infant oral care with the help of a specially prepared colored printed booklet. Kruskal-Wallis test was used to explore the associations between the age, education and socioeconomic class and knowledge; Wilcoxon signed-rank test was used to compare pre- and post-knowledge score.Results: Median preoral health knowledge-attitude score was found to be 4 (0-8) and was found to be associated with the level of education (P = 0.014) and socioeconomic class (0.019). There was a significant improvement in the median postknowledge score to 7 (2-10) (P < 0.001) following oral health educational session in all categories.Conclusions: An integrated preventive oral health checkup and educational program to pregnant women can benefit the dental health of the women and children. Prenatal care workers can be involved to disseminate the oral health awareness to pregnant women during antenatal visits. [ABSTRACT FROM AUTHOR]

Background: The caregivers of patients with first episode psychosis (FEP) experience significant distress. It is important to understand their needs to plan adequate interventions for them. Aim: The aim of this study was to explore the needs of caregivers of young patients with FEP in India, using a qualitative approach. Methods: The study was conducted in two phases. In phase I, a script for conducting focus group discussions (FGDs) with caregivers was developed, based on literature search and expert opinion generated from FGD with mental health professionals. In phase II, five FGDs were conducted with 30 caregivers of young patients with FEP having minimal of 6 participants in each FGD. Data was analyzed using principles of grounded theory. Results: Seven broad themes and subthemes of the needs of caregivers emerged from the FGDs. The final themes, which highlighted the needs of caregivers of young patients with FEP, were (in order of ranking) as follows: information regarding treatment, information regarding illness, services provided by the government, optimum quality of care from treatment facility, management of psychosocial issues related to patient's illness, availability and accessibility of treatment, and identification and recognition of mental health and physical problems in family members. Conclusion: Qualitative method was useful to identify the needs of the caregivers of young patients with FEP in multiple domains. [ABSTRACT FROM AUTHOR]

Disability is complex, dynamic in nature, multidimensional, and most contested. Quality of life is an abstract concept that is related to the level of disability in the population. Approaches to measuring disability vary across different regions, and purpose and application of the findings. We systematically reviewed the studies that have been undertaken to study the prevalence of disability and its association with sociodemographic factors and quality of life among the general population in India, between January 2000 and June 2018. The prevalence of impairment ranged from 1.6% to 43.3%. In major surveys, males had higher impairment than females. Studies that used the International Classification of Functioning, Disability and Health concept for measuring disability reported prevalence ranging from 70.0% to 93.2%. Most studies used semi-structured questionnaires for measurement of disability. Some studies have used Barthel Index for Activity of Daily Living, Instrumental Activities of Daily Living, Indian Disability Evaluation and Assessment Schedule, Rapid Assessment of Disability scale, and Standard Health Assessment Questionnaire. The quality of life was low among females. This review brings out the heterogeneity in the concepts for measuring disability and quality of life. Lack of standardization in the measurement of disability restrains any comparison between these studies. [ABSTRACT FROM AUTHOR]