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Background: Little information is available from India about the psychological impact of COVID-19 on helath-care workers. Aim: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. Materials and Methods: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). Results: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (

A recent study showed the association of minor alleles of rs2228611 (T allele) and rs2114724 (T allele) of DNMT1 with schizophrenia (SZ) and suggested their effects on splicing of the transcripts. We performed a replication study using 310 controls and 304 SZ patients and confirmed the association of the homozygous minor allele genotypes with SZ ( P = 0.04 for rs2114724 and P = 0.007 for rs2228611). This significant association persisted after Bonferroni correction when the previously published data of 301 controls and 325 patients were also considered ( P ≤ 0.0002). In addition, we found that the proportion of male patients with homozygous minor alleles at rs2114724 was significantly higher than that of females ( P = 0.002). When haplotype analysis of both loci was performed, we observed a significant association of T/T–T/T and T/T–C/T ( P = 0.04) haplotypes with SZ. To gain insights into the functional effects of the two SNPs on the levels of DNMT1 transcripts, quantitative real-time PCR experiments were performed using peripheral blood monocytes from 10 individuals each with T/T–T/T (homozygous minor allele), C/T–C/T (heterozygous), and C/C–C/C (homozygous major allele) haplotypes. Independently, the levels of DNMT1 protein were also compared in three individuals each by immunofluorescence. These results suggest that neither DNMT1 transcript nor the protein levels were significantly different in the peripheral blood monocytes among the individuals studied for the three groups. Taken together, our results confirm that the two minor alleles in homozygosity are associated with SZ but with no discernible effects on transcript or protein levels of DNMT1 in the peripheral blood monocytes of the small number of samples tested.

A recent study showed the association of minor alleles of rs2228611 (T allele) and rs2114724 (T allele) of DNMT1 with schizophrenia (SZ) and suggested their effects on splicing of the transcripts. We performed a replication study using 310 controls and 304 SZ patients and confirmed the association of the homozygous minor allele genotypes with SZ (P = 0.04 for rs2114724 and P = 0.007 for rs2228611). This significant association persisted after Bonferroni correction when the previously published data of 301 controls and 325 patients were also considered (P ≤ 0.0002). In addition, we found that the proportion of male patients with homozygous minor alleles at rs2114724 was significantly higher than that of females (P = 0.002). When haplotype analysis of both loci was performed, we observed a significant association of T/T–T/T and T/T–C/T (P = 0.04) haplotypes with SZ. To gain insights into the functional effects of the two SNPs on the levels of DNMT1 transcripts, quantitative real-time PCR experiments were performed using peripheral blood monocytes from 10 individuals each with T/T–T/T (homozygous minor allele), C/T–C/T (heterozygous), and C/C–C/C (homozygous major allele) haplotypes. Independently, the levels of DNMT1 protein were also compared in three individuals each by immunofluorescence. These results suggest that neither DNMT1 transcript nor the protein levels were significantly different in the peripheral blood monocytes among the individuals studied for the three groups. Taken together, our results confirm that the two minor alleles in homozygosity are associated with SZ but with no discernible effects on transcript or protein levels of DNMT1 in the peripheral blood monocytes of the small number of samples tested.

Introduction: Undertaking a research project is mandatory for MD Psychiatry trainees. The present study was undertaken to assess the type of research activity being undertaken as part of MD Psychiatry dissertation, and its contribution to national and international literature. Materials and Methods: Three medical colleges supplied the data about the topic, names of the supervisor and the candidate, collaboration, funding accrued, and publication details of MD-based research carried out between years 2000 and 2010 inclusive; 95 records were collected for the final analysis. The details of the publications provided were cross-checked on the internet, which would have taken care of missed publications as well. Results: Most studies were single-point assessment clinical studies. Only 2 studies had been funded, 11 had collaboration with other departments within the same institute, and 5 had inter-institute collaborations. Majority of the studies were not published. Only 30 were published as full paper and 9 as abstracts. Of these 30 full publications, only 3 were published in journals having JCI impact factor values (1.4, 1.3, and 1.4, respectively). Conclusions: The main finding of this pilot study was that MD-based research has low contribution to the national and international literature, and those articles which are published are in low impact journals. Suggestions for modifying this state of affairs are discussed.

Repetitive transcranial magnetic stimulation (rTMS) has been used widely in adult patients with depression and resistant auditory hallucinations. There is a paucity of data for rTMS use in geriatric patients for these indications. Recent research has revealed newer avenues for the use of rTMS in clinical geriatric psychiatry practice which includes mild cognitive impairment and dementia. rTMS is also being looked at as an effective treatment when combined with cognitive training in the management of Alzheimer's disease. The present review discusses the various uses of rTMS in geriatric psychiatry. This paper analyzes the various studies done with rTMS in older patients in various indications and the safety and efficacy of the procedure are also evaluated. The need for further studies in this area using larger samples is also mentioned.

Suicide is a common occurrence in psychiatric disorders and is a cause of increased healthcare utilization worldwide. Schizophrenia is one of the most common psychiatric disorders worldwide and posited to be seen in 1% of the population worldwide. Suicide is a common occurrence in schizophrenia with 25%–30% patients with schizophrenia attempting suicide and 8%–10% completing it. There is a need for valid biological markers to help clinicians identify patients with schizophrenia that may be at a risk of suicide and thus help in them receiving better care and interventions at the earliest even before a suicide attempt occurring. There are clear neurobiological changes at a genetic, neuroimaging, and neurochemical level that occurs in patients with schizophrenia that attempt suicide. There is a new theory that postulates neuronal plasticity and neuroprotection to have a role in the biological changes that ensue when suicidal thoughts and feelings occur in patients with schizophrenia. Neurotrophic growth factors like brain-derived neurotrophic factor (BDNF) have been documented to play a role in the protection of neurons and in the prevention of neurobiological changes that may lead to suicide both in schizophrenia and depression. The present paper presents a commentary that looks at the role of BDNF as a protective factor and neurobiological marker for suicide in schizophrenia.

Gender dysphoria is a new entity introduced in the Diagnostic and Statistical Manual of Mental Disorder V to address the distress of the previously labeled gender identity disorder patients. It is less commonly seen in natal females, often starting in their childhood. Adults and adolescent natal females with early-onset gender dysphoria are almost always gynephilic. This case report is presented to discuss the interesting evolution of the symptoms in gender dysphoria case with difficulties in adjusting to the assigned sexual role, relationship problems, morbid jealousy, and severe depressive features with suicidal ideations.

Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for management of dementia, in the year 2007. (http://www.indianjpsychiatry.org/cpg2007.asp). The current version of the CPG is an update of the earlier version of CPGs for management of dementia There were three separate CPGs for management of dementia, one each for Reversible Dementias, Alzheimer's Disease and Vascular Dementia, Please note that the present CPG on dementia deals all types of dementia together. The current version of the CPGs for dementia in elderly must be read in conjunction with the previous version of CPGs for dementia. The focus of the present CPG is to provide suggestions and clinical tips to differentiate dementia syndrome from other clinical conditions, identify the subtypes of dementia and then offer suggestions for management. These guidelines only provide a broad framework for assessment, management and follow-up of older people with dementia. While most of the recommendations are evidence based, these guidelines should not be considered as a substitute of professional knowledge and clinical judgment. The recommendations made as part of these guidelines should be tailored to address the clinical needs of the individual patient and the treatment setting.

There is a growing incidence of dementia patients in the community, and with this growth, there is need for rapid, valid, and easily administrable tests for the screening of dementia and mild cognitive impairment in the community. This review looks at the two most commonly used tests in dementia screening, namely, the clock drawing test (CDT) and the mini-mental status examination (MMSE). Both these tests have been used in dementia screening over the past three decades and have been the subject of scrutiny of various studies, reviews, and meta-analysis. Both these tests are analyzed on their ability to assess dementia and screen for it in the community, general practice and general hospital settings. The methods of administration and scoring of each test are discussed, and their advantages and disadvantages are explained. There is also a direct comparison made between the MMSE and CDT in dementia screening. Future research needs with these tests are also elucidated.

BACKGROUND: Suicide is an act of intentionally causing one's own death. Number of suicidal incidences is proportional to attempted suicide cases hence if attempt cases are reduced, number of suicidal death can also be decreased and for that purpose risk factors should be identified and reduced. Therefore, this study is planned to identify risk factors among lower socioeconomic rural population of surrounding areas of Hyderabad in India. MATERIALS AND METHODS: This was a prospective study in which all the suicide attempt cases reported at Bhaskar Medical College and General Hospital were included. The study period was from January 2013 to July 2013. They were undergone a detailed psychiatric interview, including their demographic details, and complete suicide risk assessment was done using Beck's suicide intent scale. RESULTS: It was found that females in the age group of 20-30 years, uneducated, married and daily laborers by occupation had higher incidence of suicidal attempts. Depressive disorder is the most common associated psychiatric disorder in both the genders, followed by alcohol use related problems. Family disputes are the other major risk factors. Most common mode for attempt was organophosphorous poisoning followed by ingestion of calotropis. CONCLUSION: Risk of suicide attempt is almost equal in terms of medium and high category of suicide assessment scale in both genders. We suggest that all individuals with alcohol related disorders must be screened for suicidal ideation so that appropriate methods can be adopted to reduce the risk. Language: en

Bipolar disorder (BPAD) is a serious mental disorder characterized by episodes of depression, hypomania/mania and mixed episodes, with interepisodic recovery. However, many patients with BPAD continue to exhibit residual symptoms in the interepisodic period. The illness usually starts in adolescence or early adulthood and has significant negative impact on the life of the sufferer and their caregivers. Patients with BPAD encounter educational difficulties, job related problems, interpersonal difficulties, psychosocial dysfunction, disability, marital problems, multiple suicidal attempts, completed suicide and medication side effects. Additionally patients with BPAD have high rates of physical and psychiatric comorbidity. The prevalence rates of BPAD vary from country to country. A large multinational study suggests that lifetime prevalence of BPAD-I ranges from 0-1% with a mean of 0.6 (SD-0.4). The prevalence rate of BPAD-II ranges from 0 to 1.1% with a mean of 0.4 (SD-0.3). Additionally a significant proportion of patients have been shown to have subthreshold BPAD with a range of 0.1 to 2.4% with a mean of 1.4 (SD-0.8). There is no nationwide study to evaluate the prevalence rates of BPAD in India. In a country like India, patients have limited resources, poor knowledge about the disorder and treatment; have inadequate access to the health care facilities, which makes treatment of BPAD a challenge. Indian Psychiatric Society (IPS) made first attempt to formulate Clinical Practice Guidelines (CPGs) for management of BPAD in 2005. Since then, over the last one decade there have been several developments, especially in the form of emergence of new evidence for some of the pharmacological agents. Accordingly, these new guidelines attempt to update the previous guidelines published by IPS. These guidelines should be read along with the earlier version of the CPGs, published by IPS in 2005.

Background: The COVID-19 pandemic has led to a complete shut-down of the entire world and almost all the countries are presently in a “lockdown” mode. While the lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, the impact of the same on mental health is not well known. Aim: This study aimed to evaluate the psychological impact of lockdown due to COVID-19 pandemic on the general public with an objective to assess the prevalence of depression, anxiety, perceived stress, well-being, and other psychological issues. Materials and Methods: It was an online survey conducted under the aegis of the Indian Psychiatry Society. Using the Survey Monkey platform, a survey link was circulated using the Whatsapp. The survey questionnaire included perceived stress scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Warwick-Edinburgh Mental Well-being Scale to assess perceived stress, anxiety, depression, and mental well-being, respectively. The survey link was circulated starting from April 6, 2020 and was closed on April 24, 2020. Results: During the survey, a total of 1871 responses were collected, of which 1685 (90.05%) responses were analyzed. About two-fifth (38.2%) had anxiety and 10.5% of the participants had depression. Overall, 40.5% of the participants had either anxiety or depression. Moderate level of stress was reported by about three-fourth (74.1%) of the participants and 71.7% reported poor well-being. Conclusions: The present survey suggests that more than two-fifths of the people are experiencing common mental disorders, due to lockdown and the prevailing COVID-19 pandemic. This finding suggests that there is a need for expanding mental health services to everyone in the society during this pandemic situation.

An appropriate real-time hydrometeorological observational network is designed and established for developing a full-scale hazard mitigation modelling system in respect of floods covering 24 river systems and cyclones covering nine coastal districts of Andhra Pradesh, east coast of India with an objective to develop an enhanced technical capacity to deal with the floods and cyclones in future using all available technologies and modelling tools. The framework includes set of hydrological and hydrodynamic models, set of regional specific models of cyclone prediction, wind hazard assessment, storm surge inundation assessment along with suitable Geographical Information System (GIS) interfacing for facilitating the quantification and spatial description of the impact of flooding and cyclone damage (in terms of storm surge inundation and wind damage on structures/infrastructure) with a sufficient lead-time so as to plan for effective relief routing plans/rehabilitation strategies. Performance evaluation of the hazard mitigation modelling systems for the past flood and cyclone events is presented in this study.

India has one of the fastest growing youth populations in the world. Girls below 19 years of age comprise one-quarter of India's rapidly growing population. In spite of India's reputation for respecting women, to an extent to treat her as a goddess, the moment a baby is born, the first thing comes to mind is "boy or girl?" as the differences are beyond just being biological. This article examines the significance of various psychological constructs and psychosocial issues that are important in the life of a "girl" baby born in our country.

To evaluate the incidence and outcomes of management of endophthalmitis following phacoemulsification and 3-piece silicone intraocular lens (IOL) implantation in a single eye unit over a 6-year period.Shrewsbury and Telford Hospital, NHS Trust, Shrewsbury, United Kingdom.Forty-four cases of endophthalmitis following phacoemulsification and 3-piece silicone IOL implantation were identified between January 1, 1998, and December 31, 2003. All the data related to the endophthalmitis cases were prospectively collected. The total number of cataract surgeries was identified from the hospital information technology department through coding data.There were 44 cases of endophthalmitis following 12 362 phacoemulsification cataract extractions (incidence 0.36%). The incidence of endophthalmitis with a silicone polypropylene IOL (0.67%) was significantly higher (P.0005) than with a silicone poly(methyl methacrylate) (PMMA) IOL (0.24%). Thirty-six patients (81.8%) had vitreous tap while 8 patients (18.2%) had vitrectomy. Twenty cases (45.5%) were culture positive. Visual acuity was 6/12 or better in 30 patients (68.8%). There was weak correlation between visual acuity at presentation and final visual outcome (Pearson correlation r = 0.33, P = .029). Final visual acuity was not significantly related to culture results (P = .85, Mann-Whitney U test) or type of presentation (P = .52, Mann-Whitney U test).In this first single-center study to report incidence of endophthalmitis following phacoemulsification and silicone IOL implantations alone, the incidence of endophthalmitis was significantly higher with silicone polypropylene IOLs than with silicone PMMA IOLs and the overall incidence of endophthalmitis following phacoemulsification surgery was higher than most of the published data.

To evaluate the Nidek handheld automated keratometer and compare it with the manual Zeiss keratometer.St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.Forty-five normal adult volunteers were included in the study. Three sets of randomized keratometry measurements were taken from both eyes of each adult, with both instruments by two independent observers. Readings included powers of the steep and flat meridians and axis of the flat meridian. The mean difference between the two instruments was calculated. The variance of each instrument was calculated for the axis, the steep and flat meridians, and the mean of the two meridians.There was no significant difference between the mean Nidek and Zeiss keratometry readings for the steep (0.015 mm; P = .167) or flat (0.054 mm; P = .069) meridian or axis measurements (P = .172). On repeated measurements, the within-subject and within-group variabilities, calculated separately for each instrument, were significantly less for the Nidek automated keratometer than the Zeiss keratometer (P.01) when measuring the steep and flat meridians. There was however, a significant increase in axis variability using the Nidek keratometer (range 20 degrees; P.01).The Nidek automated keratometer was accurate, reliable, and easy to use and compared favorably with the manual Zeiss keratometer when measuring corneal curvature. In the handheld mode, the Nidek is not suitable for axis measurements. It has the additional advantage of portability.

Byline: T. Sathyanarayana Rao, G. Rao, M. S. V. K.. Raju, Gautam. Saha, Mukesh. Jagiwala, K. Jacob The recent past has been turbulent for Lesbian Gay Bisexual and Transgender (LGBT) people and Gay Rights in India. The Delhi High Court's landmark judgment in July 2009, which read down Section 377 of the Indian Penal Code, was a major victory. It held that Section 377 to be violative of Articles 21, 14, and 15 of the constitution, as it criminalized consensual sexual acts of adults in private.[sup][1] The judgment struck down a 19[sup]th century law, which the police used to threaten and blackmail LGBT people. Violation of the law is punishable by a fine and imprisonment. Subsequently, India's Supreme Court issued a ruling against human rights by reinstating the law that bans gay sex in 2013.[sup][2] The response from mental health and legal establishment to this manifest bigotry was weak.[sup][3] The hesitancy of the establishment to clearly support LGBT rights exposes their subscription to prevailing societal prejudices. Fortunately, the Supreme Court referred a batch of curative petitions against Section 377, to a five-judge Constitution Bench for an in-depth hearing.[sup][4] The Science Modern medicine and psychiatry, since the 1970s, have abandoned pathologizing same-sex orientation and behavior.[sup][5] The World Health Organization accepts same-sex orientation as a normal variant of human sexuality.[sup][6] The United Nations Human Rights Council values LGBT rights.[sup][7] Psychiatry's new understanding is based on studies that document a high prevalence of same-sex feelings and behavior in men and women, its prevalence across cultures and among almost all nonhuman primate species.[sup][8],[9] Investigations using psychological tests could not differentiate heterosexual from homosexual orientation. Research also demonstrated that people with homosexual orientation did not have any objective psychological dysfunction or impairments in judgment, stability, and vocational capabilities. The consistency of same-sex attractions, the failure of attempts to change, the lack of success with treatments and the harm caused by these efforts support the stability of homosexual orientation.[sup][3],[8],[9] Science continues to debate the relative contributions of nature and nurture, biological and psychosocial factors, to sexuality.[sup][3],[8],[9] However, classical theories of psychological development employ untestable conjectures and argue without proof that the origins of adult sexual orientation lie in childhood experience and development. Similarly, genetic and biological theories are reductionistic and do not explain complex aspects of human behavior, including natural inclination and choice. The universality of same-sex orientation and behavior and variations in its meaning and practice across cultures undermine single and simplistic explanations. Human sexuality is complex; the distinction between desire, behavior, and identity acknowledges the multidimensional nature of sexuality.[sup][3],[8],[9] The fact that these dimensions may not always be congruent in individuals suggests the complexity of the issues. Bisexuality and the discordance between biological sex and gender role and identity add to the complexity. The Cultural Context Anti-LGBT attitudes once considered the norm, have changed over time in many social and institutional settings in the west. However, heterosexism is also common; it idealizes heterosexuality and considers it the standard while denigrating and stigmatizing all nonheterosexual forms of behavior, identity, relationships, and communities. Religious and social orthodoxy and patriarchy complicate the issues in many conservative and tradition-bound societies. This is particularly true in India, making it difficult for LGBT people to be accepted as equals in society.[sup][3],[8],[9] The hesitancy of the Indian medical and legal establishments to fully support LGBT rights exposes their subscription to prevailing societal prejudices. …

Background: It is now well-established that chronic pain and depression are interrelated but the exact reasons for this association remain unclear. Although, in the majority, chronic pain is the source of depression; in a few, chronic pain is a manifestation of depression. The objective of this survey was to study the pattern of socio-demographic characteristics of persons with depression and chronic pain carried out by online survey. Materials and Methods: Two-hundred and ten psychiatrist from all over India were selected randomly from those who were registered with the Indian Psychiatry Society. Online survey was conducted with these psychiatrists. Survey questionnaire included 16 questions on depression with chronic pain. Results: One hundred and fourteen psychiatrist responded on online survey. The data was compiled and analyzed. The results showed that 201 patients/week visit psychiatric clinics.47% psychiatrist say 15-30% present with chronic pain, 35% say depression with chronic pain is present in 20-40% patients. Eighty-four percent psychiatrist say pain and depression are related to each other. Forty-one say 25-50% patients of chronic pain have depression. Conclusion: The results of this survey showed that chronic pain and depression co-exist commonly.

The psychological impact of the assassination of Prime Minister Indira Gandhi on psychiatric inpatients was studied. A semistructured interview indicated faulty perception of, and inappropriate reaction to, the event and its implications in the patients, often colored by their background and illness. The Modified Brief Psychiatric Rating Scale indicated a significant rise in their psychopathology soon after the event.