Transcranial direct current stimulation as early augmentation in adolescent obsessive compulsive disorder:A pilot proof-of-concept randomized control trial

BACKGROUND Transcranial direct current stimulation(tDCS)is proven to be safe in treating various neurological conditions in children and adolescents.It is also an effective method in the treatment of OCD in adults.AIM To assess the safety and efficacy of tDCS as an add-on therapy in drug-naive adolescents with OCD.METHODS We studied drug-naïve adolescents with OCD,using a Children’s Yale-Brown obsessive-compulsive scale(CY-BOCS)scale to assess their condition.Both active and sham groups were given fluoxetine,and we applied cathode and anode over the supplementary motor area and deltoid for 20 min in 10 sessions.Reassessment occurred at 2,6,and 12 wk using CY-BOCS.RESULTS Eighteen adolescents completed the study(10-active,8-sham group).CY-BOCS scores from baseline to 12 wk reduced significantly in both groups but change at baseline to 2 wk was significant in the active group only.The mean change at 2 wk was more in the active group(11.8±7.77 vs 5.25±2.22,P=0.056).Adverse effects between the groups were comparable.CONCLUSION tDCS is safe and well tolerated for the treatment of OCD in adolescents.However,there is a need for further studies with a larger sample population to confirm the effectiveness of tDCS as early augmentation in OCD in this population.

Efficacy of repetitive transcranial magnetic stimulation in treatmentresistant depression:the evidence thus far

Depression is a common mental disorder, which attributes to significant morbidity, disability and burden of care. A significant number of patients with depression still remain symptomatic after adequate trials of antidepressant treatment as well as psychotherapy, which is often referred to as treatment-resistant depression. Neuromodulation techniques—like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, may be useful augmenting techniques in depression, mostly recommended for treatment-resistant cases. Robust evidence exists regarding the efficacy of electroconvulsive therapy in the management of treatment-resistant depression;however, other techniques are understudied. TMS has been increasingly studied in various psychiatric disorders including depression. It has been approved by the US Food and Drug Administration for use in major depressive disorder. Over the past two decades, TMS has been studied in diverse groups of the population with depression using several research designs. This article gives an overview of the efficacy of repetitive TMS in treatment-resistant depression with the recent evidence.

Relevance of early intervention in Fahr's disease: understanding through a case study

SUMMARY Intracranial calcification may result from disturbances in calcium metabolism. It often remains asymptomatic, but may present with symptoms like seizure and neurological deficits. Correction of the underlying metabolic disturbance before damage of neuronal tissues due to intracranial calcification may be useful in preventing irreversible neurological deficits. This window period may be the crucial period that needs a thorough clinical evaluation and urgent intervention. We highlight the case of an adult woman with Fahr's disease presented with generalised tonic-clonic seizure. The management priorities were also discussed along with review of literature.

Mental health promotion for elderly populations in World Health Organization South-East Asia Region:Needs and resource gaps

The accelerated population growth of the elderly(individuals aged 60 years or more)across the globe has many indications,including changes in demography,health,the psycho-social milieu,and economic security.This transition has given rise to varied challenges;significant changes have been observed in regard to developing strategies for health care systems across the globe.The World Health Organization(WHO)is also engaging in initiatives and mediating processes.Furthermore,advocacy is being conducted regarding a shift toward the salutogenic model from the pathogenic model.The concept behind this move was to shift from disablement to enablement and from illness to wellness,with the notion of mental health promotion(MHP)being promoted.This article attempts to discuss the MHP of elderly individuals,with special reference to the need to disseminate knowledge and awareness in the community by utilizing the resources of the health sector available in the WHO South-East Asia Region countries.We have tried to present the current knowledge gap by exploring the existing infrastructure,human resources,and financial resources.There is much to do to promote the mental health of the elderly,but inadequate facilities are available.Based on available resources,a roadmap for MHP in elderly individuals is discussed.

Cross-Sectional study of internalised stigma and medication adherence in patients with obsessive compulsive disorder

Background Patients suffering from psychiatric disorders tend to stigmatise themselves which had been linked to poor adherence to treatment.Aims The aim of the present study was to study internalised stigma and medication adherence and to assess the relationship between them in patients with obsessive compulsive disorder(0CD).Methods A cross-sectional study was conducted on 112 patients diagnosed with 0CD who were attending the Out-patient's department at Department of Psychiatry of a tertiary care hospital in North India.Internalised stigma and current medication adherence were assessed with Internalized Stigma of Mental Illness Scale(ISMI)and Medication Adherence Rating Scale,respectively.Yale-Brown Obsessive Compulsive Scale was used to assess the current severity of OCD symptoms.Sociodemographic and clinical details were also obtained from the patients by using a semistructured sociodemographic proforma.Results Most of the patients reported moderate level of internalised stigma with a mean ISMI score of 77.98(10.82).Most of the patients were compliant while 41.96%reported poor medication adherence.Internalised stigma was negatively correlated with the current medication adherence.Current severity of OCD symptoms also showed a significant positive correlation with internalised stigma and a significant negative correlation with medication adherence.Conclusion High levels of internalised stigma were associated with lower adherence to treatment which suggests that internalised stigma may be a very important factor influencing medication adherence in patients with OCD.

How far has panic buying been studied?

BACKGROUND Although panic buying(PB)is a ubiquitous behavior,it became prominent during the coronavirus disease 2019 pandemic.However,studies are inadequate to explore the different aspects of it,even though it covers several perspectives of life and academic domains.AIM To assess the research that have been conducted on PB.METHODS A search was conducted to identify the articles in PubMed,PubMed Central,Scopus,and Google Scholar using the search term“panic buying”on November 15,2020.A total of 104 articles was extracted from the initial search.After removing duplicates and initial and full-text screening,42 articles were included in the study.We only considered peer-reviewed published articles that can be downloaded in a full portable document format.Articles published in other languages and preprints were excluded.RESULTS Among the 42 articles,27 were original contributions,6 were correspondences,3 were commentaries,3 were review articles,and there was one each for editorial,opinion,and discussion type of articles.Several domains have been researched such as psychology,responsible factors,supply chain,management,disaster preparedness,e-commerce,consumer behavior,marketing,prevention strategies,media,social network,economics,personality,and engineering.Authors from several disciplines,such as psychiatry,management,economics,business,sales and marketing,consumer behavior,public health,communication,information management,sociology,engineering,business administration,psychology,nursing,health economics,food policy,epidemiology,and community health,have been studied it.Definition,causative model,econometric model,controlling strategy,and measuring instrument have been reported.A total of 18 papers had cross-country collaboration,and ten were funded projects.Most of the authors were affiliated with the institutions of Australia,Bangladesh,China,India,Singapore,and the United States.CONCLUSION PB is a relatively newer concept to get the attention of the research community.Further robust studies with replication of the findings are warranted to explore,predict,and control during crises.

Phenomenology,disability and sexual functioning in female Dhat syndrome:a study of tertiary care gynaecology outpatients

Background Dhat syndrome,a clinical condition related to semen loss in urine often found among males in India,has rarely been described as a separate clinical condition in females.Women with the syndrome complain of passing vaginal discharge and can be excessively concerned and preoccupied with it,often attributing various physical symptoms to the loss of vaginal fluids.Aims This study aimed to assess the sociodemographic and clinical profiles of female patients with Dhat syndrome and their perceived stress,disability and sexual functioning.Methods Sociodemographic details of 70 females with non-pathological vaginal discharge were evaluated with a semistructured sociodemographic assessment.The phenomenology of the vaginal discharge was assessed with the Scale for Assessment of Female Dhat Syndrome Questionnaire.Anxiety and depressive symptoms were measured with the Hospital Anxiety and Depression Scale.Perceived stress in the past month and disability caused by the illness were assessed with the Perceived Stress Scale and the World Health Organization Disability Assessment Scale.In addition,the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition,Level 2 Somatic Symptoms Scale was administered to rate the severity of somatic symptoms,and sexual functioning was evaluated using the Female Sexual Function Index(FSFI)scale for women who had had sexual intercourse in the past month.Results The mean age of onset vaginal discharge was 23.0(6.6)years.Biological factors,such as urinary tract infection,were the commonly attributed cause of the loss of vaginal fluids.Psychiatric comorbidity and perceived moderate stress in the past month were found in 38.6%and 68.6%of female patients with Dhat syndrome,respectively.Disability scores tended to be low.Among the females having had sexual intercourse in the past month,48.3%had FSFI scores indicative of a female sexual disorder.Conclusions The clinical presentation of women with non-pathological vaginal discharge is similar to that of males with Dhat syndrome.It requires comprehensive assessment and management that targets the biological,social and psychological factors and cultural issues.

Suicide in Nigeria:observations from the content analysis of newspapers

Background Suicide is a global public health problem and Nigeria is one of the epicentres of suicide in the world.However,there is a dearth of research exploring the epidemiological aspects of suicide in Nigeria.Aim To examine the demographic information and precipitating events for suicides in Nigeria by analysing the contents of newspaper reports of suicide.Methods We searched,collected,and analysed published news reports about suicide from 10 English newspapers in Nigeria.A total of 350 suicide reports were assessed between January 2010 and December 2019 after screening and sorting.Results The mean(SD)age of the reported cases was 36.33(15.48)years.Majority of the reported cases were male(80.6%),married(51.8%),students(33.6%),living in a semi-urban area(40.3%)and among the age group of 25-34(25.3%).Hanging(48.6%)and poisoning(32.2%)were the most commonly reported methods of suicide.Financial constraints and marital conflicts were most commonly assumed precipitating factors.Conclusion This study suggests that being male,married,or living in semi-urban areas are associated with suicide in Nigeria.Further community-based studies are warranted to generalise the findings and adopt appropriate preventive strategies.

Zolpidem dependence in an adult with bipolar affective disorder and epilepsy: A case report

Zolpidem is a short-acting non-benzodiazepine hypnotic agent,commonly recommended for short-term treatment of insomnia.Zolpidem has less dependence potential than benzodiazepines.Patients with mental illnesses often have disturbed sleep,for which zolpidem is often prescribed.Long-term use and self-medication(in more than recommended doses)are more likely to cause dependence.We report here a case of bipolar affective disorder with epilepsy,who developed dependence to zolpidem and had severe withdrawal symptoms.The management issues are also discussed with review of the literature.