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Purpose: Gall bladder cancer (GBC) is one of the commonest and deadliest cancers of Northern and Eastern India. The absence of a population-based cancer registry in Uttar Pradesh and Bihar has resulted in a lack of statistical information even though data from several hospital-based registries suggests that incidence rates of GBC may be one of the highest in the world. We present the four-year data on GBC from our tertiary-level multispeciality hospital. Materials & Methods: This is a retrospective and analytical study. All patients of histopathologically proven GBC over four years were included and geographic, demographic and clinical data was collected and presented. Follow up, where available, was used to assess survival at 12 months and factors affecting it. Results: A total of 245 patients with GBC were diagnosed during the study period of which more than two-thirds were women. The majority of cases at our hospital were from the state of Uttar Pradesh with the highest number coming from the Eastern districts closer to the river Ganga and its tributaries. 26.5% of cases were early stage and surgically resectable, 19.6% were locally advanced and unresectable while 53.9% were metastatic at presentation. Age, stage and radical surgery as treatment had a significant association with survival at 12 months. Conclusion: GBC has an extremely high incidence in the Northern plains of India. There is a high suspicion of its association with increasing pollution of the major rivers of the region. Early detection is crucial as definitive surgery is the only curative option with any significant improvement of survival.

Byline: Swarndeep. Singh, Raman. Deep Pregnancy in women with bipolar disorder (BD) can be considered a high-risk pregnancy in view of several clinical and pharmacotherapeutic considerations. Pharmacological treatment during pregnancy [...]

To evaluate the risk factors associated with lifetime suicide attempts in bipolar disorder (BD) patients. 773 BD patients with a duration of illness of at least ten years, currently in clinical remission, were evaluated for suicidal attempts in their lifetime. Those with and without lifetime suicide attempt(s) were compared for various demographic and clinical risk factors. 242 (31.3%) patients had a history of at least one lifetime suicide attempt. Compared to those without lifetime suicide attempts, those with suicidal attempts were less educated, were more often females, spent more time in episodes, and had a significantly more number of total episodes (in the lifetime, first five years of illness, and per year of illness), had significantly more number of total depressive episodes (in the lifetime, first five years of illness, and per year of illness), spent more time in depressive episodes, had more severe depressive episodes, more often had depression as the first episode in the lifetime, spent more time in mania/hypomania/mixed episodes, had higher residual depressive and manic symptoms, more often had rapid cycling affective disorder pattern in the lifetime, use of cannabis in dependence pattern, had poorer insight into their illness and had a higher level of disability (especially in three out of the four domains of Indian disability evaluation assessment scale). About one-third of the patients with BD have at least one-lifetime suicidal attempt, and those with suicide attempts usually have a poorer course of illness. [ABSTRACT FROM AUTHOR]

Background & objectives: Cingulum bundle (CB) is frequently implicated in schizophrenia; however, its role in specific symptoms of schizophrenia such as auditory verbal hallucinations (AVHs) is less explored. Few studies have reported association between reduced integrity of CB and severity of AVH. Using a symptom-based approach, this diffusion tensor imaging (DTI) tractographic study was aimed to assess and compare the integrity of CB in schizophrenia with AVH, schizophrenia without AVH and healthy controls. Methods: A total of 92 right-handed adult individuals (aged 18-50 yr) were recruited across three study groups. Those with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) diagnosis of schizophrenia with AVH (group I; n=30) were compared to those with DSM-5 schizophrenia without lifetime AVH (group II; n=32) and healthy controls (group III; n=30; screened using Mini International Neuropsychiatric Interview version-7.0.0. and negative family history). Clinical assessments (groups I and II) included scale for assessment of positive symptoms, scale for assessment of negative symptoms, clinical global impression-schizophrenia and psychotic symptom rating scale. All participants underwent DTI, and quantitative tract-based measurements of fractional anisotropy (FA) were obtained for images using DTI studio version-3.0. Results: All groups were comparable for age, gender, education and severity of illness. Group I had significantly lower FA values in the cingulate gyrus (CG) part of the left CB compared to groups II and III. No significant difference was found between groups II and III. Interpretation & conclusions: The findings of this study suggest that the disruption in the left CB appears to be specific for AVH-positive schizophrenia. The finding is, however, preliminary subject to replication in future studies. Further investigations are needed to understand its relevance in the context of AVH-positive schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Relatively limited literature is available on lethality assessment for suicide attempts in affective disorders from the Indian subcontinent. Aims: To assess the lethality and its clinical correlates in lifetime suicide attempters with mood disorders. Methods: A total of 100 lifetime suicide attempters, aged ≥18 years, with a DSM-5 diagnosis of bipolar disorder (BD) or major depressive disorder—recurrent (MDD-R) were recruited. Current euthymia was ascertained (Hamilton Depression Rating Scale (HAM-D) ≤7; Young Mania Rating Scale (YMRS) ≤4). Assessments were conducted using clinical pro forma, Risk–Rescue Rating Scale (RRRS), Columbia Suicide Severity Rating Scale (C-SSRS) and Barratt's Impulsiveness Scale (BIS). Results: Average age of the sample was 36.32 ± 11.76 years (48% males, 52% females). The mean duration of affective illness was 10.59 ± 8.32 years. Risk–rescue scores for lethality were significantly higher in males (vs females), bipolar disorder (vs unipolar), multiple attempters (vs single) and planned (vs unplanned) attempters. Risk–rescue score also showed a significant positive correlation with lifetime total and depressive episodes, and intensity of ideations, and a significant negative correlation with BIS—attention impulsiveness. Regression analysis [F (3,96) = 12.196, P < 0.001, adjusted R2 = 0.253] found that lifetime lithium prescription, intensity of suicidal ideations and attention impulsiveness explained 25.3% variance in lethality. Conclusion: Absence of lifetime lithium, higher intensity of suicidal ideations and lower attentional impulsiveness predicted higher lethality of suicide attempts. Lethality of suicide attempts was found to be associated with a multitude of clinical factors, notably male gender, bipolarity, multiple attempts, planned attempts and number of total and depressive episodes. Assessment of lethality and its correlates can help to plan strategies towards risk prevention in mood disorders. [ABSTRACT FROM AUTHOR]

In India, more than 90% of the patient with chronic mental illness stayed with their family members. Approximately 77.4% of caregivers experience moderate to severe levels of aggression. The purpose of this study was to evaluate the effectiveness of caregiver-training program on knowledge in managing aggressive behavior of mentally ill at home. Research design was pre-experimental. Seventy two caregivers were recruited using purposive sampling technique. The caregivers knowledge was assessed at 3 time points with regard to training program; before, immediately (post-test 1), and after 1 month (±1 week; post-test 2). The baseline knowledge was reflective of the deficiencies existing in the management of aggression of the mentally ill by caregivers. The knowledge of caregivers regarding the management of aggressive behavior of mentally ill, increased after caregiver training program, from the pre-test score of 17.63 ± 3.3 to post-test 1 score of 23.26 ± 2.9, and slightly decreased post-test 2 score of 21.01 ± 3.3 at p <.05. Repeated measure analysis of variance (ANOVA) was done to compare the differences in knowledge score over time with Bonferroni adjustment. This home based caregiver training program helped caregivers to identify etiological factors of aggression, warning signs of aggression and use of de-escalation strategies to manage aggressive behavior of mentally ill. Training caregivers regarding aggression management will make caregiver proficient in practicing safe approach during handling of aggressive patient which will ensure the physical safety of the caregiver as well as of the patient and let the patient stay at home. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to assess the effectiveness of educational package regarding knowledge of Somatic symptom disorders among adolescent girls. Methods: 75 adolescent girls were selected by using non probability convenient sampling technique. The data was collected by using a reliable and validated tool to assess the knowledge regarding Somatic symptom disorders. Results: The quantitative assessment of knowledge regarding Somatic Symptom Disorders revealed that after administration of educational package, 56 (74.67%) adolescent girls had average knowledge and 19 (25.33%) adolescent girls had adequate level of knowledge. There was significant difference between knowledge in pre testand post test after administration of educational package. Also, thepost test knowledge was statistically associated with educational level of father of adolescent girls (0.043), educational level of mother of adolescent girls (0.046) and occupation of mother of adolescent girls (0.003). The study revealed that, the pretest mean score value of knowledge was 9.52 with standard deviation (SD) of 2.21 and the post-test mean score value of knowledge was17.00 with SD of 4.01 with a mean difference of 7.48.The calculated-t value was 13.87. This indicated that there was a high statistical significant difference in the pre and post test knowledge level regarding Somatic symptom disorders among adolescent girls, p value 0.05. Conclusion: Results of this research generates evidence that educational package regarding knowledge of Somatic symptom disorders among adolescent girls was effective. [ABSTRACT FROM AUTHOR]

Background: Persons with disability (PwD) are entitled to certain benefits from the State on grounds of being disabled. With the recent enactment of the Rights of PwD Act, 2016, and increased efforts to provide assistance to persons with certifiable disabilities, data pertaining to disability requests can be useful to understand the way in which services are utilized. Materials and Methods: This study is an audit of the disability certificates issued to all subjects with age ≥18 years between 2016 and 2019 at a tertiary care general hospital psychiatry unit, and discusses the pattern and profile of the certificates. Results: A total of 356 patients were issued disability certificates (2016-2019). The mean age of the subjects was 32.8 (±11.2) years and about 30% of them were females. Intellectual disability (58.3%) was the most common diagnosis, followed by schizophrenia and related disorders (31%), while all other disorders constituted a smaller proportion (11%) of the sample. About 60% of the subjects had moderate disability, 37.4% had severe disability, and 1.7% had profound disability. Conclusion: A large majority of the certificates were issued to subjects with intellectual disability. Patients with severe mental illnesses are probably not accessing the disability benefits optimally. This audit also points to under-representation of women as well as an overall underutilization of services by individuals with mental disability. [ABSTRACT FROM AUTHOR]

Suicide is a major public health problem and one of the leading causes of deaths worldwide. The effects of suicide go beyond the person who acts to take his/her life; it can have lasting effect on family, friends and communities. The role of a nurse specific to suicide prevention includes both system and patient level interventions. Objectives of the study: · To assess the existing knowledge and attitude regarding care of attempted suicide patients among staff nurses. · To evaluate the effectiveness of self –instructional module regarding care of attempted suicide patients among staff nurses. · To find out the association of post -test knowledge and attitude regarding care of attempted suicide patients among staff nurses with selected demographic variables. Materials and Methods: In this pre- experimental research study non probability convenient sampling technique was used to select 60 staff nurses from selected Hospitals. A self- structured questionnaire and attitude scale was used to assess the knowledge and attitude of the staff nurses regarding the care of attempted suicide patients. Result: The finding of the study revealed that majority 95% (57)of staff nurses had moderate knowledge and only 5% (3) had inadequate knowledge regarding care of attempted suicide patients in pre-test. After going through Self Instructional Module, 83.37 % (50) of the staff nurses had adequate knowledge and 16.66% (10) had moderate knowledge regarding care of attempted suicide patients. The attitude scale findings revealed that 100% (60)of staff nurses had neutral attitude regarding care of attempted suicide patients in pre-test and in post-test 100%(60) had positive attitude regarding care of attempted suicide patients. Conclusion: Study concludes that going through Self-Instructional module helps method in improving knowledge and attitude of the staff nurses regarding care of attempted suicide patients. [ABSTRACT FROM AUTHOR]