PRECISION NEUROMODULATION & SCHIZOPHRENIA: THE NEXT FRONTIER?
Dr. Aaditya S., Dr. Umesh S., Dr. Nishant Goyal. Central Institute of Psychiatry, Kanke, Ranchi – 834006.
Introduction:
Schizophrenia is a complex, chronic mental health disorder characterised by an array of symptoms. In particular, its negative and cognitive symptoms represent an unmet therapeutic need, with neuromodulation in the form of transcranial electrical stimulation (tES) presenting a possible solution. However, tES as a technology remains in its infancy, with a pressing need for more precise targeting. Precision gamma-transcranial alternating current simulation (γ-tACS) delivered to the prefrontal cortex via Geodesic Transcranial Electrical Neuromodulation (GTEN) could represent a way forward.
Aims:
To compare the effects of adjunctive precision γ-tACS on negative and cognitive symptoms in patients with schizophrenia between active and sham groups.
Methodology:
In 10 patients of schizophrenia with predominant negative symptoms, baseline assessment of negative symptoms and cognitive deficit was done, followed by a structural MRI. The MRI data was segmented into seven tissue types and merged with digitised electrode sensor positions of the 256-channel Geodesic Sensor Net (GSN). Using Finite Element Modelling, individual head models (IHMs) were created, after which areas for targeting were selected. Active or sham 40Hz γ-tACS was administered via GSN for 10 sessions over 5 days.
Results:
Patients who received active treatment showed significant improvement in negative symptoms as measured by SANS and cognitive deficit tested by MoCA, TMT and Stroop Task, when compared with sham. Minimal side effects were reported during the sessions.
Discussion:
Prefrontal cortical hypoactivity with reduced gamma band oscillations possibly underlies the pathophysiology of negative and cognitive symptoms in schizophrenia. Exogenously administered γ-tACS targeted to individual cortical geometry via IHMs leads to effective gamma entrainment and improvement of symptoms.
Conclusion:
The successful application of 40Hz γ-tACS via GTEN in the active group of patients represents apossiblebreakthrough in our quest to treat schizophrenia, and warrants urgent further research to generalise these findings.
Keywords:
Schizophrenia, Neuromodulation, tACS, Precision.
Hindi Translation and Validation of Young’s Internet Addiction Test
Dr. Ayush Singh1, Dr. Lokesh Kumar Singh1, Dr. Ajay Kumar1
1Department of Psychiatry, AIIMS, Raipur
Aims/Objectives – We aimed to translate and validate Young’s Internet Addiction Test (IAT) into Hindi addressing the lacunae of Hindi instrument for internet addiction.
Methodology - Translation Process (Phase 1): Hindi IAT translation followed WHO and ITC guidelines, involving forward & back translations, expert reviews, and cognitive interviews with 10 bilingual Hindi speakers for linguistic/conceptual equivalence. Testing (Phase 2): Cross-sectional study in Raipur targeted active Hindi-speaking internet users aged 18-65, Sample size 400 which supported factor analysis (20 respondents/item).
Results- Phase-1 achieved high face validity (90%). Phase-2 established strong construct validity through factor analyses, yielding a robust 17-item four-factor model. Cross-language and convergent validity (with daily internet usage) were excellent. Reliability was solid with internal consistency (α = 0.873), split-half reliability (λ2 = 0.850), and test-retest reliability (r = 0.945). HIAT-17 cut-offs were established, revealed 18.3% problematic Internet use and 1.5% severe dependence. Negative correlations were observed with age and age of internet use onset, while positive correlations were found with daily usage time, monthly spending, data pack size, watching porn, online gaming, and social media. Income showed no significant correlation.
Discussion - The research emphasized the importance of a meticulous translation process to ensure that the Hindi IAT accurately measured internet addiction within the Hindi-speaking population. The prevalence of internet addiction among Hindi speakers exhibited variations and similarities with global, Asian, and Indian prevalence trends. Factors associated with internet addiction showed correlations with socio-demographic variables, providing insights into the complex dynamics of internet addiction.
Conclusion - The study confirmed Hindi IAT’s reliability and validity for assessing internet addiction in the Hindi-speaking population. Future research should delve into regional variations in addiction prevalence and determinants.
Telepsychiatry consultations: What works and what doesn’t- from a neutral observer’s viewpoint
Background: Since the Covid-19 pandemic, telepsychiatry has become normalised across India as one of the primary methods of care delivery. However, no research has tried to look into the interaction and experience of the participants in the consultation (clinician, patient and caregiver) from a neutral observer’s perspective.
Objective: This study was conceptualised as an unique opportunity to understand how the interaction between the participants happen during a telepsychiatry consultation.
Methodology: A psychiatrist who was not a part of the telepsychiatry consultation assessed the interaction on a questionnaire specifically designed for this study to document the various aspects of the consultation on a 6-point Likert scale. The consultation involved evaluation of patients by three consultants during the detailed evaluation of these patients. The sociodemographic and clinical details of the patients were also recorded during the observation.
Results: A total of 122 teleconsultations were observed. The patients had a mean age of 44.6 years, were mostly male, married, educated beyond matric and belonged to urban joint families. The average distance of their location from the hospital was 150 km. About three-fifth (61.4%) of the patients were diagnosed with mood and anxiety disorders, and 8.2% with psychotic disorders. The average time spent in the telepsychiatry consultation was 24.7 minutes. In 63.9% of the consultations there were no technological problems, while 23% had connectivity issues from the patient side. In 67.2% of the consultations, the clinicians introduced themselves to the patient. In more than 85% of the consultations, the clinicians assessed for affective symptoms and anxiety symptoms, and in 66% they asked for psychotic symptoms. In most of the consultations (89.3%) the patients were given time to ask questions. While in > 70% consultations, the clinicians explained the diagnosis and plan of management to the patient, in only 28.7% of the consultations, the psychiatrists talked about what to do in case of an emergency. In >85% of the consultations, the patient and/or caregivers were cooperative and were positively involved in the interview and discussion.
Conclusion: In teleconsultations, while clinicians tend to do a thorough assessment of the psychiatric symptoms, and the patients are mostly cooperative and involved, the practice of introducing oneself and discussing what should to be done during an emergency needs to be improved.
Resilience in Adolescent Offspring of Parents With Severe Mental Illness(SMI)
Gayathri Rajan*1 Akhilesh Sharma2
1Senior Resident DM, Department of Child and Adolescent Psychiatry, PGIMER, Chandigarh
2Associate Professor, Department of Child and Adolescent Psychiatry, PGIMER, Chandigarh
(Corresponding author*-g3cr.89@gmail.com,9995172621, IPS-LOM/G05/22)
Background
Children who encounter adversities and do well despite challenges, are resilient.
Aim
The aim of the study was to study resilience and its correlates in adolescent offspring of parents with SMI, outcomes associated with resilience and relationship between resilience and the associated factors as well as processes.
Methodology
60 patients, with a clinical diagnosis of SMI(30 parents each with Schizophrenia and Bipolar Affective Disorder) and having offspring (12-18yrs). The diagnosis of the parent was confirmed using Mini International Neuropsychiatric Interview 7.0.2. The sociodemographic and clinical profile , the Adverse Childhood Experience International Questionnaire (ACE-IQ), Adolescence Resilience Questionnaire, Strengths Difficulties Questionnaire , Alabama Parenting Questionnaire Child and Parent version, Digit Symbol Substitution Test (DSST), GlobalAssessment of Functioning(GAF) & the Child Behaviour Checklist Youth Self-Report were used. Statistical analysis was carried out using SPSS. Ethical safeguards were maintained.
Results
The offspring had a significant exposure for 11.35 years to parental illness. Average age of offspring was 15.199 ± 2.37. Factors associated with good resilience are- late age of onset of parental mental illness, lower socioeconomic status score, being an offspring of parents with bipolar illness. There is high presence (100.00%) of childhood adversity, most common being emotional neglect. ACEs are significant negative correlates of resilience, competency, and functioning. ACEs are significantly more in offspring of schizophrenia.
The cognitive and parenting processes are better in offspring’s of BPAD parents.78.33% of offspring in the whole group, 76.66% in group 1 and 80.00% in group 2, have GAF score above 90, implying superior functioning. Significant predictors of resilience are parenting scores of child version, socioeconomic status, years of exposure to parental mental illness and DSST-T.
Conclusion
There are protective psychosocial and clinical factors as well asACEs and poor resilience processes in index study. These have interacted in a such a way that competency and functioning is good.
Key words: Resilience, Offspring, Adverse Childhood Experience(ACE)
Prevalence of Obstructive Sleep Apnoea and its association with Metabolic syndrome among patients suffering from Psychotic illness
Gopika Jagota, Sandeep Grover
Aim: To evaluate the prevalence of Obstructive Sleep Apnoea (OSA) and its association with Metabolic syndrome among patients suffering from Psychotic illness. Methodology: 105 patients suffering from a psychotic illness were assessed on Berlin sleep apnoea questionnaire for OSA and metabolic syndrome was assessed using the Consensus Criteria given by the International Diabetes Federation. Results: The mean age of the study sample was 34.1 years (SD: 10.1). About one-sixth (n= 18; 17.1%) patients were considered to be at high risk of developing OSA. The mean number of criteria met for metabolic syndrome were 2.3 (SD: 1.1) and about half (n=49; 46.7%) patients fulfilled the criteria for metabolic syndrome. Patients with a BMI of ≥ 25 kg/m2, and raised waist circumferencewere at a higher risk of developing OSA. No association was found between presence of metabolic syndrome, and high risk of OSA. Conclusion: Although patients with psychotic illnesses have high prevalence of metabolic syndrome, presence of metabolic syndrome is not associated with higher risk of developing OSA. Higher risk of OSA is associated with raised BMI and increased waist circumfernce.
Is Pregnancy related anxiety linked to perceived social support-An observational study among third trimester antenatal females.
Dr Isha Kaur Arora, Dr Pratibha Gehlawat, Dr Navratan Suthar, Dr Tanu
Gupta, Dr Pratibha Singh, Dr Charu Sharma
Aims: To assess the relationship between pregnancy related anxiety with perceived social support in third trimester antenatal females.
Methodology: Over a period of 16 months, 124 third trimester antenatal females were cross-sectionally assessed. Socio-demographic and clinical details were obtained. Pregnancy related anxietywasassessed usingthePerinatalanxietyscreeningscale(PASS), and thePregnancyrelated anxiety questionnaire revised 2 (PRAQ R2) and perceived social support using the Multidimensional scale for perceived social support (MSPSS).
Results: A total of 124 respondents participated in the study. The mean age of the sample was 27.2 ± 4.054 years. Out of 124 study participants 50 (40.3%) screened positive on PASS scale. Anxious group had a significantly higher number of people who were graduates or above (p = 0.028). Anxious group had a significantly higher number of ANC visits (p = 0.031). The total MSPSS scores and all its domains were significantly lower in the anxious group (Total p =0.002, Significant other p = 0.006, Family p = 0.031 and friends p = 0.004). Significant negative correlations were found between the total MSPSS scores and the total PRAQ R2 scores and all the domains of PRAQ R2.
Discussion: In this cross-sectional study, around 40% of the women were found to have anxiety during the third trimester pregnancy. Higher education was found to be associated with higher anxiety. Anxiety is also significantly associated with perceived social support.
Conclusion: The study helps to understand the factors associated with pregnancy related anxiety and also concludes that higher social support is associated with lower anxietyin pregnant females.
Women and substance use: A decade long reflection on socio-clinical statistics from State Drug Dependence Treatment Centre in Haryana
Principal author: Dr. Jagriti Yadav* (IPS Membership Number: LOM/J06/23)
Co-authors: Dr. Sunila Rathee* Dr Sidharth Arya* Dr. Rajiv Gupta (IPS Membership Number Life Fellow: 18062)*
Email: jagritipsyc07@gmail.com
Contact No.9416337745
* Institute of Mental Health, Pt. B D Sharma Universityof Health Sciences, Rohtak
Introduction: Women substance use is a major public health concern which is overlooked due to highly gendered approach towards substance use disorders. This worrisome situation is further complicated by lack of service utilisation due to various socio-cultural factors.
Aim& Objective: We aimed to collect structured information on socio-clinical characteristics of women using substance, rather than mere calculation of prevalence.
Materials & Methods: A chart review was conducted for all women substance users presenting our state level outpatient facility for the period of January 2013 to December 2022. A 19-item standard assessment proforma based on Drug Abuse Monitoring System was used for documentation after semi-structured interview by the professionals.
Results: Women constituted a small fraction of our service users(1.1%). Majoritywere middle aged married homemakers from rural background with no formal education. The primary substance of use was tobacco (64.3%), followed by opioids (37.2%), sedatives (13.2%) and alcohol (10.1%). A significant proportion (29.41%) reported prescription opioid misuse. The commonest reason for initiating substance use was physical discomfort in the form of pain due to various causes (44.2%). 85.4% women were introduced to opioid by medical practitioners. Common co-occurring psychiatric diagnoses were mood disorder (17.65%), followed by psychotic disorders (8.82%) and anxiety disorders (4.90%). Substance use among women was significantly associated with complete lack of follow up visits.
Conclusion: Substance use among women is largely seen as contrary to their socially normative roles. Therefore, it becomes pertinent to address the unmet needs of women using substance, primarily with targeted preventive strategies at community level.
Psychiatric morbidities in Fantasy Gaming: A Multicentric Cross-sectional Study
Maj (Dr.) Markanday Sharma1, Dr. (Maj) Arka Adhvaryu (Retd)2, & Surg Cdr (Dr.) Amit Chail3
1Graded Specialist, Dept of Psychiatry, Military Hospital, Jhansi (Uttar Pradesh): LOM/M22/21 2Senior Resident, Dept of Psychiatry, RG Kar Medical College, Kolkata (West Bengal): LOM/A09/22 3Classified Specialist, Dept of Psychiatry, Command Hospital (WC), Chandigarh: LOM/A01/18
Abstract
Background: Fantasygaming apps (FGAs) have been increasing inIndia. While there have been advertised lucrative aspects, the mental health concerns are also alarming. Whilst it is likely a casual hobby for the majority, a minority of vulnerable individuals’ may have a detrimental impact on their lives as it may act as a gateway to hard-core gambling. Due to lack of scientific evidence, there is a need for formal studies assessing the rates of psychiatric morbidities among users of FGAs in India.
Aim: To assess the psychiatry comorbidities associated with use of fantasy games
Methods: A multicentre cross-sectional study was done over 03 months including patients who presented to Psychiatric OPD with increased Fantasy game use. Scales used were Problem Gambling Severity Index, PHQ-9, HAM-D, DASS-21 and C-SSRS.
Results: Amongst the 45 patients, age ranging from 20-45, male female ratio was 8:1, 50 % of them gainfully employed, 80% of them having severe problem gambling, with maximum use of Dream 11 and My11circle (around 30%), 20% of them having self-harm ideation, with 10% actual attempt, 30% of them having severe stress and anxiety, and around 15 % with clinical depression. 80 % patients had comorbid substance use disorders.
Discussion: Excessive use of FGA is associated with depression, anxiety, financial losses, familial discord and various other socio occupational impairment.
BACKGROUND: Sensory perceptual alterations in bipolar disorder have been mentioned in DSM-5 and ICD-10. But visual perceptual processing abnormalities have not been studied using neurophysiological correlates before in acute manic phase. There is a need for a study that tests visual perception during a manic episode.
AIM: To test visual perception in patients during acute manic phase using P300 of ERP in correlation with a questionnaire assessing perception subjectively.
METHODOLOGY: Cross Sectional hospital-based study conducted at Central Institute of Psychiatry, Ranchi with a sample size of 20 subjects undergoing a manic episode and 20 matched healthy controls.
RESULTS: P300 amplitude was significantly higher in midline frontal cluster (p=0.04) and left temporal cluster (p=0.05) in patients as compared to controls. P300 latency was significantly shorter in Right central cluster (p=0.04) and in Right parietal cluster (p=0.03) as compared to healthy controls.
CONCLUSION: Patients in manic phase of illness have better top down processing and have better evaluation speed of information when compared with healthy controls as seen by higher P300 amplitude and shorter P300 latency respectively in patients experiencing a manic episode. Patients experiencing a manic episode may have heightened visual perception.
An Exploratory Study Evaluating Perceived Stress, Mental Well-Being and Quality of Life Among Homeless Women in Delhi
Priyanka Saha1, Shalini Singh Achra1, Rajesh Kumar2, Alok Agrawal1, Atul Ambekar1
1Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
2Executive Director, Society for Promotion of Youth and Masses (SPYM), New Delhi, India
Email: drpriyanka614@gmail.com
Aims and Objectives: Homeless people are exposed to various stressors like lack of stable housing, social exclusion, unemployment and poverty which impacts their mental health and overall quality of life. This study investigates and documents perceived stress, mental well-being and quality of life among homeless women in Delhi.
Methodology: A cross-sectional observational study with purposive sampling was used to recruit 152 homeless women receiving services from urban shelter homes in Delhi. Instruments: semi-structured questionnaire exploring information regarding socio-demographic status, details of homelessness, reproductive health and violence, WHO Quality of Life – BREF, Perceived Stress Scale, Depression (PHQ-9), Somatic Symptom Scale (PHQ-15) and Anxiety (GAD-7). Descriptive statistics are presented for the entire cohort of participants.
Results: The median (IQR) age of the participants was 30 (25-38) years. More than 80% of the participants were unemployed/engaged as low-wage workers. Around 90% reported poverty was a major reason for homelessness other reasons were family conflict and abandonment, substance use by a spouse, violence by spouse/family members and divorce/separation. The median (IQR) duration of homelessness was 20 (5-30) years. Around 30% of the women reported a history of abortion and the major reproductive issues faced were dysmenorrhoea (38.2%) and menorrhagia (22.4%). Almost 60%of the women had experienced intimate partner violence. Participants had a higher physical 50.00 (44.0-56.0) and psychological health score of 50.00 (38.0-63.0) and a lower social relationships score of 31.00 (25.0-56.0). More than 70% of the women reported moderate stress, 15% of the women reported moderate to severe depression, 15% scored medium to high severity in PHQ-15 and 2% scored moderate to severe anxiety in GAD-7.
Conclusion: Homeless women experience a higher prevalence of intimate partner violence, stress, poorer mental well-being and quality of life in comparison to the general population.
Hence addressing the difficulties faced by homeless women is very important.
Case report: Episodes of Dissociative trance & possession disorder and psychotic presentation due to Grave’s hyperthyroidism .
Presenting author:- Dr Ritu Meena (Associate professor)
NIIMS Jaipur, Rajasthan
Introduction:-
Graves disease accounts for one of the most common cause of thyrotoxicosis and presence of psychiatric symptoms with Graves disease is common like depression , anxiety , insomnia, restlessness etc .But episodes dissociative trance & possession disorder and psychotic presentation secondary to Grave’s hyperthyroidism are rare.
Aims & objective :-To assess the clinical correlation between dissociative trance & possession disorder and psychosis with Graves hyperthyroidism.
Case:-
A 28 year old female was brought by her husband With complaint of two separate episodes of trance and possession. According to husband in between episodes she said that “ mai devi hu “ “mere andar devi aati “ bhot sekhti hai devi ne di hai “and there was no jerkey movement ,injury or big talks associated with episodes.In between episodes she talked in voice of small girl .she also had Sleep distrubance , wondering tendency ,aggression & disrobing of clothes since 45 days.Blood investigation were normal accept Thyroid profile there was thyroid dysfunction present. Patient referred to endocrinology department where patient was Diagnosed with grave ‘s hyperthyroidism . Referred to surgery department for neck swelling they found small ,smooth and firm thyromegaly . So the patient was diagnosed as dissociative trance & possession disorder and psychotic symptoms due to Grave’s hyperthyroidism.
Result :-
Patient was started on injectable antipsychotics & benzopdiapines after which was no further episode of Dissociative trance and possession, psychotic symptoms decreased and sleep was improved .Tab carbamazole & LUGOL ‘s IODINE was prescribed by endocrinology department.Total thyrodectomy was done by surgery department after that patient shows significant improvement.
Discussion /conclusion:-
Dissociative trance & possession and psychotic symptoms are rare with Grave’s hyperthyroidism
Paper submitted for Dr K C Dubey Poster Award Session at Annual conference of IPS at Kochi in January 2024: A Study on Gender Differences in Depression, Self Esteem, Body Image Disturbances andQuality of Life in Patients of Androgenetic Alopecia
1. Dr. Shruti Tagde (Presenting author)
2nd year Resident, Department of Psychiatry
Seth GSMC and KEM Hospital
Mumbai
2. Dr. Suraj Singh
Ex Resident, Department of Psychiatry
Seth GSMC and KEM Hospital
Mumbai
3. Dr Neena Sawant
Prof& HOU, Department of Psychiatry
Seth GSMC and KEM Hospital
Mumbai
Corresponding Author:
Dr Shruti Tagde(Presenting Author)
2nd year Resident, Dept of Psychiatry
Seth GSMC and KEM Hospital,
Mumbai
Email: shrutisharad37@gmail.com M:7769941149
Background: Androgenetic alopecia is one of the commonest with prevalence increasing with age and is associated with feelings of anxiety, depression, anger, less satisfaction with the body and lower self-worth.
Aim: We undertook this study to find out the gender differences in depression, self-esteem, body image disturbance and quality of life in patients of androgenetic alopecia.
Methods: This cross-sectional, observational study was initiated after taking permission from the institutional ethics committee and written informed consent of the patient in the specialized Hair OPD of the department of dermatology of a general municipal hospital. 103 patients diagnosed as androgenetic alopecia by the dermatologist were recruited and interviewed with a specially prepared proforma and scales to determine the aims of the study. Becks Depression Inventory (BDI) was used to assess for depression, Body Image Concern Inventory (BICI) for body image concerns, Rosenberg’s Self-Esteem Scale (RSES)for self- esteem and Dermatology Life Quality Index (DLQI) for quality of life.
Result: There were 84 males and 19 females in the study. 36 males and only 4 females had depression as per BDI (U -566.5, p - 0.04) which was statistically significant. However, on comparing for gender differences on BICI (U -684.5, p-0.33), RSES (U -740.5, p-0.6) and DLQI (U -638.5, p-0.17) no significant differences were seen.
Conclusion: The results of this study imply that depression was seen more in males which was significant. It is important for dermatologists and physicians to be aware about the psychiatric co morbidities so that patients can be referred early.
Key words: Androgenetic Alopecia, Depression, Self-esteem, Body image, quality of life