Publications by authors named "Sandeep Grover"

645 Publications

Pharmacometabolomics-guided clozapine therapy in treatment resistant schizophrenia: Preliminary exploration of future too near.

Asian J Psychiatr 2021 Nov 24;67:102939. Epub 2021 Nov 24.

Department of Psychiatry, PGIMER, Chandigarh, India.

Aim: To study the association of clozapine pharmacometabolomics and clozapine response in Asian patients with treatment-resistant schizophrenia (TRS).

Method: A cross-sectional study was performed on 50 consecutive TRS patients following up in psychiatry department of the tertiary care hospital. Demographic details, response assessment, were collected on the case record form. A blood sample was also collected for trough concentration assessment of drug and its metabolites. Clozapine (CLZ) the parent drug and its two major metabolites - Clozapine N oxide (CNO) and N-Desmethyl clozapine (N-DSMC) levels were assessed using a high-performance liquid chromatography method. Clozapine responders and nonresponders patients were classified based upon Andreasen criteria.

Results: The average trough concentration of CNO, N-DSMC, and CLZ were 123 ± 76.04, 171.93 ± 93.24, 229.27 ± 124.25 ng/ml, respectively. The two patient subgroups did not differ for CLZ, CNO, and N-DSMC concentrations statistically. However, clozapine nonresponse was associated with a higher CLZ/N-DSMC ratio (p = 0.03) and clozapine dose (p = 0.01). The receiver operator characteristic curve showed that the cut-off CLZ/N-DSMC ratio of 1.54 with a sensitivity of 85% and a positive predictive value of 84% for identifying nonresponders.

Conclusion: CLZ/N-DSMC ratio and clozapine dose were identified as significant variables for future dose optimization algorithms. Pharmacometabolomics-guided clozapine therapy has the potential to revolutionize TRS management.
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http://dx.doi.org/10.1016/j.ajp.2021.102939DOI Listing
November 2021

Concordance of assessment of insight by different measures in obsessive-compulsive disorder: An outpatient-based study from India.

Indian J Psychiatry 2021 Sep-Oct;63(5):439-447. Epub 2021 Oct 12.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Aims: This study aimed to examine the (a) prevalence of various levels of insight among patients with obsessive-compulsive disorder (OCD) and (b) correlation of insight specifier (Diagnostic and Statistical Manual [DSM]-5) and other established measures of insight in OCD.

Methods: One hundred and twenty-five outpatients with a diagnosis of OCD were assessed by Brown Assessment of Beliefs Scale (BABS) and DSM-IV's insight specifier. The insight specifier of DSM-5 was determined by item one ("conviction") of BABS. Dimensional Yale-Brown Obsessive-Compulsive Severity Scale was used to assess the frequency and severity of dimensional obsessive-compulsive (OC) symptoms.

Results: The mean age of the participants was 31.2 (±11) years. Seventy-seven (61.6%) of the participants were men. There was a high correlation ( = 0.73) between the insight specifiers of DSM-5 and DSM-IV. Insight categories of DSM-5 had modest correlations with BABS total score and BABS-based insight categories. Significant associations were observed between the level of insight and comorbid psychotic illness, hoarding and symmetry dimensions of OC symptoms, severity of depressive, and OC symptoms. The first two associations were consistent across group comparisons (insight-groups based on DSM-IV and BABS) and correlation (with total BABS score).

Conclusions: Majority of the patients with OCD have good insight and application of different tools influence the assessment of insight in OCD. The DSM-5 insight specifier has strong and significant correlation with the DSM-IV's insight classification and categorization of insight by BABS.
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http://dx.doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_1380_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522613PMC
October 2021

Knowledge and attitude of caregivers of people with dementia.

Geriatr Gerontol Int 2021 Nov 9. Epub 2021 Nov 9.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Aim: This study aimed to evaluate the knowledge and attitude of caregivers of people with dementia towards the disease (Alzheimer disease). The secondary objective of the study was to assess the association of attitude and knowledge towards dementia.

Methods: In total, 50 patients with dementia and their caregivers were included in the present study. Caregivers were evaluated on the Dementia Attitude Scale and Alzheimer's Disease Knowledge Scale (ADKS) to assess the level of knowledge and attitude.

Results: The mean age of patients was 72.2 years, and the majority of them were men, married, from joint/extended family setup, urban background, and upper or upper-middle socioeconomic status. The mean age of the caregivers was 48.04 years, and the majority was educated more than the matric level. Nearly half of the caregivers were children, and about one-third were the spouse of the person with dementia. The mean duration of the caregiver role was 3.6 ± 3.0 years, while the average time spent in caregiving was 7.4 ± 2.9 h/day. Using the Alzheimer's Disease Knowledge Scale, the mean knowledge score for the caregivers was 16.9 ± 2.7. In terms of individual items on the knowledge scale, most of the caregivers were aware of most aspects of dementia. In terms of the mean weighted score, the maximum score was for the domains of course and symptoms and this was followed by the domain of "treatment and management." The lowest score was obtained for the domain of assessment and diagnosis on ADKS. On the Dementia Attitude Scale, the mean total score was 76.4 ± 18.4. The mean total score for the knowledge domain was higher than the support domain.

Conclusion: The current study suggests that most caregivers with dementia have a reasonable level of knowledge about dementia. However, in terms of attitude, caregivers of people with dementia have a less positive attitude towards dementia. The study's finding suggests that there is a need to evaluate the knowledge and attitude of the caregivers of people with dementia and the gaps must be addressed to improve the outcome, both for the people with dementia and their caregivers. Geriatr Gerontol Int 2021; ••: ••-••.
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http://dx.doi.org/10.1111/ggi.14304DOI Listing
November 2021

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists.

Psychiatry Investig 2021 Nov 5;18(11):1058-1067. Epub 2021 Nov 5.

Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Objective: Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists' attitude toward polypharmacy has been under debate.

Methods: We developed an original questionnaire about Psychiatrists' attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.

Results: The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively).

Conclusion: Policy on polypharmacy may influence psychiatrists' decision-making. Thus, policies considering rational polypharmacy should be established.
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http://dx.doi.org/10.30773/pi.2021.0169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600221PMC
November 2021

A scientometric study of publications on delirium from 2001 to 2020.

Asian J Psychiatr 2021 Dec 20;66:102889. Epub 2021 Oct 20.

Formerly with CSIR-NISTADS, New Delhi 11012, India.

Aim: This study aims to evaluate the publications on delirium by using bibliometric analysis.

Methodology: The Scopus database was evaluated for publications on delirium, during the period of 2001-20. The search results were analyzed for the origin of country, origin of institution, authorship, collaborations, type of article, source of funding, and number of citations.

Results: The searches of Scopus database yielded 22,941 publications, originating from 139 countries. Compared to the decade of 2001-2010, the number of publications on delirium doubled in the decade of 2011-2020. The majority of the papers were research articles (58.26%), and the papers were cited for mean number of 20.53 times. Only a small proportion of the papers were based on funding (13.14%). Maximum number of papers emerged from United States of America. In terms of institutional affiliations, among the authors from top 20 institutes, 15 were from United States, 2 from Netherlands and 1 each from Canada, Germany and United Kingdom. In terms of authors, the research productivity of the top 20 most productive authors varied from 172 to 612 publications with 12 authors belonging to United States, 2 from Italy and 1 each from Canada, Greece, India, Ireland, Netherland and the United Kingdom. The maximum number of papers were published in Journal of the American Geriatric Society and based on the number of citations the New England Journal of Medicine was the most impactful journal.

Conclusion: Over the years number of publications on delirium have increased, majority of the publications have emerged from United States.
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http://dx.doi.org/10.1016/j.ajp.2021.102889DOI Listing
December 2021

Impact of the COVID-19 Pandemic on Consultation-Liaison Psychiatry Services: An Exploratory Study From a Tertiary Care Center in North India.

Prim Care Companion CNS Disord 2021 Oct 21;23(5). Epub 2021 Oct 21.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of psychiatric care, including consultation-liaison psychiatry (CLP) services. The objective of this study was to assess the demographic and clinical profiles of psychiatric referrals made to CLP services during the pandemic period and compare to data during the same timeframe from the previous year at a tertiary care center in North India.

Data of patients referred for CLP consultation and seen by the CLP team in the medical-surgical wards wherein COVID-negative patients were admitted during the period of March 24, 2020, to October 11, 2020 (approximately 6.5 months, 201 days) were extracted from the CLP register (routinely maintained). These data were compared with that of the same timeframe from the previous year (March 24, 2019, to October 11, 2019).

During 2020, a total of 562 patients were referred to CLP services, in contrast to 1,005 patients referred in 2019, suggesting a 44% reduction in the number of referrals made to CLP services. During 2020, CLP referral patients more often had metabolic/endocrine disorders, myocardial infarction, and peripheral vascular diseases and less often had chronic obstructive pulmonary disease/asthma and autoimmune disorders compared to 2019. Also, the number of referrals made to CLP services in 2020 for treatment of new disorders declined significantly ( < .001), whereas referrals for abnormal behavior/uncooperativeness ( < .001), self-harm attempts ( = .007), and other reasons (evaluation for organ transplant, sleep disturbances;  = .029) increased significantly. Further, significantly higher percentages of patients were diagnosed with delirium ( = .03) and depressive disorders ( = .04) in 2020 compared to 2019.

There was a significant increase in the number of psychiatric referrals for depressive disorders and self-harm attempts among admitted patients from medical-surgical units during the COVID period. These findings suggest that there is a need to modify CLP services to address the needs of patients referred to CLP services, especially during the COVID-19 pandemic.
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http://dx.doi.org/10.4088/PCC.21m02973DOI Listing
October 2021

A cross sectional study to assess tobacco use and its correlates among patients attending non-communicable disease clinics of a Northern Jurisdiction in India.

J Family Med Prim Care 2021 Aug 27;10(8):2915-2922. Epub 2021 Aug 27.

Department of Health and Family Welfare, State NCD Control Cell, Punjab, India.

Background: Non-Communicable Diseases (NCDs) continue to rise unabated globally and the existing evidence has unequivocally established the relationship between tobacco use and NCDs. In 2010 the Government of India (GOI) introduced NCD clinics under the National Program for Prevention and Control of Cancer, Diabetes, Cardio Vascular Diseases and Stroke (NPCDCS) with the purpose of preventing and combating the NCD epidemic. This study was undertaken with an objective to comprehensively determine tobacco use and its correlates among patients attending these NCD clinics.

Methods: A descriptive cross-sectional study was carried out among 1172 patients attending NCD clinics at district level, in Punjab, India between May to October 2018. Using systematic sampling every fourth patient was interviewed and equal numbers of visits were made to both the clinics.

Results: Overall, the current tobacco use in any form was reported to be 10.2% among the study respondents. Majority of the tobacco users were males (23.3%), in 40-49 year age group, (18.7%), residing in urban area (15%), educated up to secondary school (18%) and non-government occupation bracket (27.4%) and hypertension disease category (41.6%). More SLT users had thought of quitting in past in comparison to smokers (46.6% vs 40%) and had higher quit attempts in past (42.5% vs 38.3%). In the binary logistic regression analysis, odds of tobacco use increased with increasing age, three times higher among participants who were employed (OR 3.75; CI 1.41-10.02),6 times higher in COPD disease category (OR 6.88; CI 2.1-20.59).

Conclusion: Higher tobacco use among the NCD clinic attendees with increasing age predisposes them to develop grave complications. This calls for the need to administer intensive behaviour change interventions for tobacco cessation at the existing NCD clinics. This could further strengthen existing health systems and thereby improving health outcomes followed by achieving Sustainable Development Goals.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_2471_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483119PMC
August 2021

Mendelian Randomisation Study of Smoking, Alcohol, and Coffee Drinking in Relation to Parkinson's Disease.

J Parkinsons Dis 2021 Oct 7. Epub 2021 Oct 7.

Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece.

Background: Previous studies showed that lifestyle behaviors (cigarette smoking, alcohol, coffee) are inversely associated with Parkinson's disease (PD). The prodromal phase of PD raises the possibility that these associations may be explained by reverse causation.

Objective: To examine associations of lifestyle behaviors with PD using two-sample Mendelian randomisation (MR) and the potential for survival and incidence-prevalence biases.

Methods: We used summary statistics from publicly available studies to estimate the association of genetic polymorphisms with lifestyle behaviors, and from Courage-PD (7,369 cases, 7,018 controls; European ancestry) to estimate the association of these variants with PD. We used the inverse-variance weighted method to compute odds ratios (ORIVW) of PD and 95%confidence intervals (CI). Significance was determined using a Bonferroni-corrected significance threshold (p = 0.017).

Results: We found a significant inverse association between smoking initiation and PD (ORIVW per 1-SD increase in the prevalence of ever smoking = 0.74, 95%CI = 0.60-0.93, p = 0.009) without significant directional pleiotropy. Associations in participants ≤67 years old and cases with disease duration ≤7 years were of a similar size. No significant associations were observed for alcohol and coffee drinking. In reverse MR, genetic liability toward PD was not associated with smoking or coffee drinking but was positively associated with alcohol drinking.

Conclusion: Our findings are in favor of an inverse association between smoking and PD that is not explained by reverse causation, confounding, and survival or incidence-prevalence biases. Genetic liability toward PD was positively associated with alcohol drinking. Conclusions on the association of alcohol and coffee drinking with PD are hampered by insufficient statistical power.
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http://dx.doi.org/10.3233/JPD-212851DOI Listing
October 2021

Management of Post-Liver-Transplant Delirium with Melatonin: A Case Report.

Indian J Psychol Med 2021 Sep 14;43(5):454-456. Epub 2020 Jul 14.

Dept. of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1177/0253717620935577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450735PMC
September 2021

Left Upper Lobectomy for Lung Cancer as a Risk Factor for Cerebral Infarction: A Systematic Review and Meta-Analysis.

Lung 2021 Oct 27;199(5):535-547. Epub 2021 Sep 27.

British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

Background: There is limited evidence on the role of the type of lobectomy after primary lung cancer with postoperative cerebral infarction (CI). The purpose of this review was to evaluate the role of left upper lobectomy (LUL) in pulmonary vein thrombosis (PVT) and eventual CI.

Methods: A search was performed on MEDLINE, Embase, and Web of Science from inception to January 2021. Prospective and retrospective cohort studies investigating the association between types of lobectomies for primary lung cancer with PVT and/or CI were included. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. A random-effect model meta-analysis was utilized if significant heterogeneity was observed.

Results: Twelve studies, including 5266 patients were included. The majority of studies were having a low risk of bias. LUL was associated with higher likelihood of CI (OR 6.27, 95% Confidence Interval (CI) 3.12-12.56; p < 0.00001) and PVT (OR 13.46, 95% CI 5.97-30.33; p < 0.00001) as compared to other lobectomies. Sensitivity analysis showed an independent role of LUL without underlying PVT in CI (OR 2.44, 95% CI 1.25-4.74; p = 0.009). Male and diabetic patients were at a higher risk, while Video-Assisted Thoracoscopic Surgery (VATS) was protective from CI.

Conclusion: The results of this review indicate that LUL after lung cancer is an independent risk factor for developing CI without underlying PVT. In addition, the risk of CI increases significantly when PVT develops after LUL. LUL is also a risk factor for PVT. A more frequent follow-up may be beneficial in lung cancer patients after LUL, especially in those with diabetes or undergoing adjuvant systemic therapy.
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http://dx.doi.org/10.1007/s00408-021-00480-4DOI Listing
October 2021

Don't forget me in amidst of COVID-19 pandemic: A case series and review of literature on steroid associated psychiatric manifestations.

Brain Behav Immun Health 2021 Dec 15;18:100345. Epub 2021 Sep 15.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.

There is a sudden upsurge in the use of steroids due to the ongoing COVID-19 pandemic, especially in patients with severe or critical COVID-19 infection. There are reports of excessive use of steroids, both in terms of use in patients who do not require the same and use in doses higher than the recommended. There are reports of the emergence of different adverse outcomes of excessive steroid use in the form of diabetes mellitus and a higher incidence of mucormycosis. However, little attention has been paid to the mental health impact of the use of steroids. This review attempts to evaluate the existing data in terms of incidence of psychiatric side effects of steroids, and the risk factors for steroid associated psychiatric manifestations. Additionally, an attempt is made to discuss the pathogenesis of steroid-associated psychiatric side effects and why it is likely that the incidence of psychiatric side effects may be more in patients with COVID-19 infection. There is a need to improve the awareness about the psychiatric side effects of steroids, both among the physicians and mental health professionals, as in any patient presenting with new-onset psychiatric symptoms while having COVID-19 infection or during the post-COVID-19 infection phase, a possibility of steroid associated side effect needs to be considered.
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http://dx.doi.org/10.1016/j.bbih.2021.100345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442258PMC
December 2021

Prevalence of internet addiction among college students in the Indian setting: a systematic review and meta-analysis.

Gen Psychiatr 2021 20;34(4):e100496. Epub 2021 Aug 20.

Post Graduate Institute of Medical Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India.

Background: The internet is an integral part of everyone's life. College going adolescents are highly vulnerable to the misuse of the internet.

Aims: To estimate the pooled prevalence of internet addiction (IA) among college students in India.

Methods: Literature databases (PubMed, Web of Science, Scopus, EMBASE, PsycINFO and Google Scholar) were searched for studies assessing IA using the Young Internet Addiction Test (Y-IAT) among adolescents from India, published in the English language up to December 2020. We included studies from 2010 to 2020 as this is the marked era of momentum in wireless internet connectivity in India. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated using the fixed-effects model. Publication bias was evaluated using Egger's test and visual inspection of the symmetry in funnel plots.

Results: Fifty studies conducted in 19 states of India estimated the prevalence of IA and the overall prevalence of IA as 19.9% (95% CI: 19.3% to 20.5%) and 40.7% (95% CI: 38.7% to 42.8%) based on the Y-IAT cut-off scores of 50 and 40, respectively. The estimated prevalence of severe IA was significantly higher in the Y-IAT cut-off points of 70 than 80 (12.7% (95% CI: 11.2% to 14.3%) vs 4.6% (95% CI: 4.1% to 5.2%)). The sampling method and quality of included studies had a significant effect on the estimation of prevalence in which studies using non-probability sampling and low risk of bias (total quality score ≥7) reported lower prevalence. The overall quality of evidence was rated as 'moderate' based on the Grading of Recommendations Assessment, Development and Evaluation criteria.

Conclusions: Our nationally representative data suggest that about 20% to 40% of college students in India are at risk for IA. There is a need for further research in the reconsideration of Y-IAT cut-off points among Indian college students.

Prospero Registration Number: CRD42020219511.
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http://dx.doi.org/10.1136/gpsych-2021-100496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381302PMC
August 2021

Management of obsessive-compulsive disorder with virtual reality-based exposure.

Ind Psychiatry J 2021 Jan-Jun;30(1):179-181. Epub 2021 Jun 17.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Little information is available about use of virtual reality exposure for management of obsessive compulsive disorder (OCD). We present a patient with OCD, who presented with significant dysfunction related to his OC symptoms and was managed with virtual reality based exposure therapy. A 27-year-old male, presented with a history suggestive of OCD for last 8 years. His symptoms were characterized by obsessive images of known people, leading to significant anxiety and distress. To get rid of his anxiety and distress, he would repeat the acts at hand, multiple times till these images would subside or till he would be able to replace these images by desirable images. These symptoms led to marked socio-occupational dysfunction. The treatment history was suggestive of minimal response to adequate trials of multiple selective serotonin reuptake inhibitors and he was on capsule fluoxetine 80 mg/day at the time of presentation. Exposure and Response therapy was tried in the past by using imaginal exposure, but this was unsuccessful, as the patient would avoid imagining the anxiety-provoking images. Hence, he was exposed to the anxiety provoking images by using virtual reality which involved presenting him with videos containing pictures of known and unknown people arranged randomly, along with the anxiety-provoking images. Over a period of 2 months, 60 sessions of ERP were carried out and the whole hierarchy was completed. This case demonstrates that virtual reality can be used in behaviour therapy for OCD, by using virtual reality techniques, and there is a need to develop software and programs for assessment and management of OCD.
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http://dx.doi.org/10.4103/ipj.ipj_33_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395545PMC
June 2021

Psychiatric morbidity in patients with idiopathic Parkinson's disease: A cross-sectional study.

Ind Psychiatry J 2021 Jan-Jun;30(1):165-174. Epub 2021 Jun 24.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objective: To evaluate the prevalence of psychiatric comorbidities in patients with idiopathic Parkinson's disease (IPD).

Methodology: Two hundred and thirty-nine patients with IPD were evaluated on Mini-International Neuropsychiatric Interview PLUS (MINI-PLUS). In addition, patients found to have depression as per the MINI-PLUS were evaluated on Beck Depression Inventory.

Results: One hundred and thirty-five (56.5%) patients had a current psychiatric diagnosis and 59.8% had a lifetime psychiatric diagnosis. As per MINI-PLUS, about two-fifth (39.7%) of patients had suicidality. In 18.8% of patients, suicidality was present in the absence of axis-I psychiatric diagnosis. Among the various psychiatric disorders, the most common disorders included depressive disorders (current: 17.5%; lifetime: 23.8%), anxiety disorders (current: 17.5%; lifetime: 17.5%), and psychotic disorders (current: 11.3%; lifetime: 11.7%).

Conclusions: More than half of the patients with Parkinson's disease have psychiatric disorders. High prevalence of psychiatric morbidity calls for close liaison between the neurologist and the psychiatric disorders.
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http://dx.doi.org/10.4103/ipj.ipj_8_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395540PMC
June 2021

Social cognition in siblings of patients with bipolar disorders.

Ind Psychiatry J 2021 Jan-Jun;30(1):157-164. Epub 2021 Jun 24.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: Identifying people at risk of developing bipolar disorder (BD) using endophenotypes is of recent interest. Few studies on social cognition in first-degree relatives of patients with BD have shown inconsistent findings. This study aimed to evaluate the social cognitive deficits (SCD) and its correlates among siblings of patients with BD.

Methodology: In this cross-sectional study, patients of BD ( = 32), their siblings ( = 32), and healthy control (HC) subjects ( = 38) matched for age, gender, and education were evaluated on social cognition rating tools in Indian setting and neurocognitive tests (color trail test, Wisconsin card sorting test [WCST], and Hopkin's verbal learning test [HVLT]).

Results: When the siblings of patients with BD were compared with patients with BD and the HCs, siblings (mean 0.6 [standard deviation [SD]: 0.2]) performed worse than the HCs (mean 0.9 [SD: 0.1]) ( ≤ 0.001) on the Faux pas composite index. Compared to HCs, siblings performed worse on all the subtests of HVLT (Trial delayed) ( < 0.001) and WCST (total correct, total errors, and conceptual responses) ( < 0.001).

Conclusion: Presence of elevated level of SCD among siblings, especially the Faux pas composite index in comparison to HCs, imply that these are stable traits, which are more often present in the patients and at risk individuals. This implies that SCD can be considered as another important endophenotype for BD.
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http://dx.doi.org/10.4103/ipj.ipj_25_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395551PMC
June 2021

Mania associated with overdose of nevirapine in an adolescent: A case report.

Indian J Psychiatry 2021 Jul-Aug;63(4):401-403. Epub 2021 Aug 7.

Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:

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http://dx.doi.org/10.4103/0019-5545.323389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363900PMC
August 2021

Sexual dysfunction in clinically stable patients with bipolar disorder receiving valproate.

Indian J Psychiatry 2021 Jul-Aug;63(4):366-371. Epub 2021 Aug 7.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Aim: This study evaluated the prevalence of sexual dysfunction in patients with bipolar disorder, while receiving valproate monotherapy.

Materials And Methods: Sixty-three clinically stable patients with bipolar disorder were evaluated on the Arizona sexual experience scale (ASEX), Udvalg for Kliniske Undersogelser (UKU) other side effect subscale and brief adherence rating scale.

Results: The mean age of the study sample was 38.84 (standard deviation: 12.49) years. About three-fourth of the participants were male (76.2%). About one-fourth (28.6%) were found to have sexual dysfunction as per the ASEX. In terms of dysfunction in specific domain of sexual functioning, depending on the cut-off used, problem with sexual desire varied from 13.33% to 35.41% among males and 6.66%-46.66% in females. Erectile dysfunction was seen in 13.33%-31.25% of males and difficulty in vaginal lubrication was reported by 13.33%-26.66% of females. When those with and without sexual dysfunction as per the ASEX were compared, it was seen that those with sexual dysfunction had significantly longer duration of illness, higher prevalence of abnormal blood pressure and higher mean scores on the UKU other side effect subscale. Both the groups did not differ on other clinical variables.

Conclusion: A significant proportion of patients receiving valproate experience sexual dysfunction. Higher prevalence of sexual dysfunction was associated with longer duration of illness, higher prevalence of abnormal blood pressure, and higher mean scores on UKU other side effect subscale.
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http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_205_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363889PMC
August 2021

Fatigue, perceived stigma, self-reported cognitive deficits and psychological morbidity in patients recovered from COVID-19 infection.

Asian J Psychiatr 2021 Oct 21;64:102815. Epub 2021 Aug 21.

Department of Anaesthesia & Critical Care, Post Graduate Institute of Medical, Education and Research, Chandigarh, 160012, India.

Background: Few studies have highlighted multiple psychosocial and physical outcomes in patients with COVID-19 infection after recovery. However, the data from developing countries is limited.

Aim: To evaluate psychological morbidity, post-traumatic stress disorder (PTSD), fatigue, and perceived stigma among patients with COVID-19 after recovery from the acute phase of COVID-19 infection.

Methods: In a cross-sectional online survey, 206 adult patients (age>18 years), recovered from COVID-19 infection completed the Patient Health Questionnaire-4 (PHQ-4), the Impact of Events Scale-Revised (IES-R), Fatigue Severity Scale (FSS), 4 items self-designed questionnaire evaluating cognitive deficits and self-designed questionnaire to evaluate perceived stigma. Additionally, they completed the information about demographic and clinical information.

Results: The prevalence of anxiety, depressive symptoms, and PTSD in the study sample was 24.8 %, 23.8 %, and 30 % respectively. About three-fifths of the participants (61.2 %) had at least one fatigue symptom as per the FSS with the mean FSS score being 32.10 ± 15.28. About one-fourth of the participants (23.7 %) reported "feeling confused and always feeling mentally foggy", and 38 % of patients reported experiencing at least one cognitive problem. The level of felt stigma related to self was seen in 31.1 %, 20 % reported stigma related to family, and 50 % reported stigma in relation to neighbors and society. Those reporting higher PTSD scores had higher anxiety and depressive scores, reported more fatigue and stigma, and had a higher level of cognitive deficits. A higher fatigue score was also associated with higher anxiety, depression, and cognitive deficits.

Conclusions: Our study reveals that a significant proportion of patients after recovery from COVID-19 experience psychological morbidities, fatigue, cognitive problems, and stigma. Efforts should be made to take care of these issues in routine post-COVID follow-up care.
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http://dx.doi.org/10.1016/j.ajp.2021.102815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379818PMC
October 2021

Incidence and outcome of COVID-19 in patients with schizophrenia: A Study from India.

Schizophr Res 2021 10 7;236:38-40. Epub 2021 Aug 7.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1016/j.schres.2021.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346351PMC
October 2021

Evaluation of Psychometric Properties of Hindi Versions of Geriatric Depression Scale and Patient Health Questionnaire in Older Adults.

Indian J Psychol Med 2021 Jul 28;43(4):319-324. Epub 2021 Jun 28.

Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: A limited number of studies have evaluated the psychometric properties of rating scales used to assess depression in the older adults. The present study aimed to assess the validity of the Hindi Geriatric Depression Scale (GDS, 30, 15, 10, 5, 4, and 1 item version) and Hindi Patient Health Questionnaire (nine and two items version) in a group of older adults residing in a rural community.

Methods: The psychometric properties of these scales were assessed against the diagnosis of depression a qualified psychiatrist made by using a semistructured interview.

Results: Total 125 older adults were recruited from a rural community, with a mean age of 65.5 (SD: 6.4) years. The prevalence of depression was 36.8% as per the evaluation by the psychiatrist. When the agreement of different scales with the clinicians' diagnosis was evaluated, it was seen that sensitivity, specificity, and Cohen Kappa value of GDS-30 and 15 were better than the other scales used to assess depression. When the sensitivity and specificity were evaluated using newer cutoffs, the specificity and sensitivity of GDS-30 were more than that of other scales.

Conclusion: Hindi version of GDS-30 with a cutoff of 13 has excellent psychometric properties.
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http://dx.doi.org/10.1177/02537176211022159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327872PMC
July 2021

Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India.

Indian J Psychol Med 2021 Jul 10;43(4):312-318. Epub 2020 Aug 10.

Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India.

Methods: This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables.

Results: About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness.

Conclusion: About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.
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http://dx.doi.org/10.1177/0253717620928782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327867PMC
July 2021

Cautopyreiophagia as a Rare Variant of PICA in a Female Adolescent: A Case Report.

Indian J Psychol Med 2021 Mar 17;43(2):180-181. Epub 2020 Dec 17.

Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1177/0253717620973389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313441PMC
March 2021

Use of Electroconvulsive Therapy in Adolescents: A Retrospective Study.

Indian J Psychol Med 2021 Mar 31;43(2):119-124. Epub 2020 Oct 31.

Dept. of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.

Background: This study aimed to evaluate the clinical profile of adolescents aged up to 19 years who had received electroconvulsive therapy (ECT).

Methods: A retrospective chart review was carried out to identify adolescents aged up to 19 years who had received ECT during the period 2012-2018. Details regarding their sociodemographic and clinical variables and ECT data were extracted from the records.

Results: During the study period, a total of 51 adolescents received ECT, and complete records of 50 patients were available for analysis. 4.04% (51 out of 1260) of the patients who received ECT were aged up to 19 years. There was a decreasing trend of use of ECT over the years. The most common diagnosis was schizophrenia (42%), and this was followed by bipolar disorder (22%) and unipolar depression (20%). The mean number of ECTs administered per patient was 8.84 (SD: 5.34; range: 1-21). On the various rating scales, the percentage improvement in patients with psychotic disorders was 77.4%. For patients with depression, the percentage improvement was 77.2%, and that for mania was 80.3%. The percentage improvement in organic catatonia was 64.6%. The number of patients achieving ≥50% response ranged from 87.5% to 100%, and when the response was defined as ≥75% improvement, the proportion of patients varied from 50% to 76.9%. The majority of patients with depression (72.7%) and mania (77.8%) achieved remission. Immediate complications associated with the use of ECT included acute blood pressure changes (18%).

Conclusion Ect Is Effective And Safe In Adolescents With Severe Mental Disorders The Clinician Should Not Hesitate And Delay The Use Of Ect In Adolescents Who Require It:
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http://dx.doi.org/10.1177/0253717620956730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313452PMC
March 2021

Can lowering of haematological monitoring for clozapine be considered in the future?

Asian J Psychiatr 2021 Oct 24;64:102796. Epub 2021 Jul 24.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1016/j.ajp.2021.102796DOI Listing
October 2021

Starting clozapine in patients with schizophrenia during the ongoing pandemic.

Schizophr Res 2021 Jul 21. Epub 2021 Jul 21.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.

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http://dx.doi.org/10.1016/j.schres.2021.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295063PMC
July 2021

Development and effectiveness of parent skills training intervention for Indian families having children with attention-deficit/hyperactivity disorder (ADHD).

Asian J Psychiatr 2021 Oct 15;64:102762. Epub 2021 Jul 15.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objective: Parent skills training interventions (PSTIs) are considered first-line treatment for ADHD. We describe development and effectiveness of a culturally-contextualised PSTI for Indian families.

Method: Forty-one families divided into 5 groups, each group with 6-10 families received group PSTI comprising of 10 weekly sessions using multi-point videoconferencing as an adjunct to routine care in the non-randomized pre-post intervention study.

Results: Thirty-six families attended more than 3 sessions. RM ANOVA revealed significant improvements in parent-rated measures of inattention (p < 0.001), hyperactivity/ impulsivity (p = 0.007), conduct problems (p = 0.002), academic performance (p = 0.001) and classroom behavior (p = 0.001). Mixed ANOVA analysis did not reveal significant differences between those who received PSTI with medication and those who received PSTI on any VADPRS domains except depression/ anxiety scores, wherein former group performed better (p = 0.008). More than 60 % parents perceived that PSTI was helpful in increasing awareness, reducing guilt/ blame, improving parent-child relation and decreasing stress. Difficulty in sustaining with the strategies was reported by 50 % of parents.

Conclusion: Findings suggest that PSTI is effective and helpful for Indian families dealing with ADHD.
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http://dx.doi.org/10.1016/j.ajp.2021.102762DOI Listing
October 2021
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