Augmenting mental health literacy of troops in a large military station: A novel approach

Background

Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops.

Materials and Methods

1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months.

Results

Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months.

Conclusions

Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

Absolute Abstinence as a Treatment Outcome in Servicemen with Alcohol Dependence: A Retrospective Cohort Study

Background: Within India's military medical framework, alcohol dependence syndrome (ADS) is deemed a treatable medical illness incompatible with military service, and complete abstinence is the only acceptable successful treatment outcome. Objective: This study was designed to identify factors which were able to differentiate treatment outcomes of abstinence and relapse among ADS patients in a military framework. Method: Recognizing personal incentives to misrepresent alcohol consumption, abstinence, and relapse outcomes were established using official reports from a patient's parent unit, in combination with biochemical parameters and clinical examination. Patients serially admitted for ADS treatment or follow-up review were surveyed, and their socio-demographic and alcohol consumption profiles, coping styles, life events and specific relapse precipitants were recorded and compared as contributory variables in a cognitive-behavioral model of ADS. From this survey of 140 patients, membership to abstainer or relapser groups was then predicted using a discriminant analysis. Results: 34% of patients achieved early absolute abstinence. No baseline socio-demographic or drinking profile distinctions existed between abstainers and relapsers. Differences were forthcoming on coping styles, life-event, and relapse-precipitant exposure measures. Stepwise discriminant analysis produced a final equation comprising 10 independent variables (including two positive life event measures), which predicted an abstinence/relapse outcome with an 86% and 79% hit-rate (original and cross-validated). Conclusion: Using prevailing cognitive-behavioral constructs, early absolute abstinence emerged as an actionable objective and an achievable goal without any contributory socio-demographic predilections. This preliminary evaluation suggests it is a tenable and realistic target of current ADS treatment programs.

Psychiatric comorbidity in multiple sclerosis

AIM

To study the prevalence of psychiatric comorbidities in patients of multiple sclerosis and their association to the degree of disability.

METHOD

Psychiatric symptoms were assessed in 90 patients of multiple sclerosis using GHQ-12, MMSE, HADS, Beck Depression Inventory and AUDIT. Neurological disability was assessed using Expanded Disability Status Scale. Correlations were determined between EDSS scores and psychiatric scale scores.

RESULT

61% of patients had significant psychological distress. Depression was most common (38.8%) which was followed by anxiety symptoms (27.8%). Cognitive functioning was relatively intact in patients with mild to moderate neurological disability. Alcohol abuse was mostly restricted to male gender.

CONCLUSION

Psychiatric illness is highly prevalent in patients of multiple sclerosis leading to poor quality of life and significant distress. Psychiatric disability was higher in patients who had greater deterioration in neurological function. All cases of MS should be assessed for psychiatric morbidities as can be alleviated by appropriate intervention.

Cognitive deficits due to thermal stress: An exploratory study on soldiers in deserts

Background

It is well known that environmental factors play an important role in human performance. High temperature and humidity particularly impair mental performance by altering brain neurochemistry and electrolyte disturbance which in turn affect one's overall efficiency. While the physiological responses to environmental heat have been well established, it is less clear about its impact on cognition. Study aims to investigate the impact of thermal strain on cognition.

Methods

One hundred (100) healthy soldiers aged between 20 and 30 years who had spent minimum of one year in desert conditions prior to their induction in the study formed sample of the study. The subjects were evaluated on memory and on cognitive functions twice i.e. in the month of February and June. The data so generated was analyzed by appropriate statistical methods.

Results

The mean age of the subjects were 25.8 yrs. There was a significant decline in cognitive performance in hot climate as compared to normal weather on Post graduate Institute (PGI) memory scale (P < 0.05). The effect was more marked for tests requiring sustained attention, concentration, psychomotor performance, verbal memory and tests of executive function.

Conclusion

The present study is the first study to be conducted in actual desert conditions. Findings revealed a detrimental impact of thermal stress on the cognitive performance of soldiers in deserts.

A cross-sectional assessment of stress, coping, and burnout in the final-year medical undergraduate students

BACKGROUND

Medical students undergo significant stress during training which may lead to own suffering or problem in patient care. High level of burnouts and depression is also not uncommon. The transition from preclinical to clinical training has been regarded as crucial to student in relation to the stress.

METHODOLOGY

An assessment of perceived stress and its relation to general psychopathology, the pattern of coping, and burnout in the final-year medical student was done to bring out clear nature, pattern, and extent of the problem.

RESULTS

Perceived stress had statistically significant association with general psychopathology and depressive-anxiety component of burnout. Acceptance, positive reframing, humor, planning, and active coping correlated with lower score on perceived stress.

CONCLUSION

Higher score on perceived stress was associated with higher scores on general psychopathology and burnout. Age of joining MBBS course and doctor in the family did not affect the stress significantly. People who displayed positive coping strategies had lesser stress and general psychopathology.

Crosssectional study of quality of life after renal transplant in end stage renal disease

BACKGROUND

End stage renal disease (ERD) is a psychologically debilitating illness with considerable emotional morbidity. There is variation in quality of life and mental health status among recipients and donor at different stages of kidney transplantation.

MATERIALS AND METHODS

The study is an observational analytic study. Sample for the study comprised of forty (40) consecutive patients including 20 recipients and 20 donors of 20 kidney transplantations, male and female, and who themselves/whose relatives provided written informed consent were included in the study. Both recipients and donors were followed-up from 2 weeks prior to transplant surgery to 6 months post-operatively by phone and when they came for review in Nephrology Out-Patient Department (OPD). Quality of life and mental health status was compared between the two groups.

RESULTS

Study groups were homogeneous on age, education, gender and marital status. After transplantation recipient's mean score in all parameters had increased and all changes were statistically significant (<0.05).

CONCLUSION

In this study significant changes in quality of life (QOL), and mental health status in recipients and donors before and after transplantation were noted. It is recommended to evaluate mental health related aspects of both donors and recipients.

Central registry in psychiatry: A structured review

BACKGROUND

Central registry in psychiatry is being practiced in few countries and has been found useful in research and clinical management. Role of central registry has also expanded over the years.

MATERIALS AND METHODS

All accessible internet database Medline, Scopus, Embase were accessed from 1990 till date. Available data were systematically reviewed in structured manner and analyzed.

RESULTS

Central registry was found useful in epidemiological analysis, association studies, outcome studies, comorbidity studies, forensic issue, effective of medication, qualitative analysis etc..

CONCLUSION

Central registry proves to be effective tool in quantitative and qualitative understanding of psychiatry practice. Findings of studies from central registry can be useful in modifying best practice and evidence based treatment in psychiatry.

Munchausen syndrome: Playing sick or sick player

Munchausen syndrome is rare factitious disorder which entails frequent hospitalization, pathological lying and intentional production of symptoms for sick role. Management requires collateral history taking, sound clinical approach, exclusion of organicity and addressing psychological issues. A case which presented with unusual symptoms of similar dimension is discussed here. The case brings out finer nuances in evaluation and management of this entity.

Interaction of media, sexual activity and academic achievement in adolescents

BACKGROUND

Adolescence is a period when the individual is vulnerable and exposure to sexually implicit/explicit programs on television and internet can influence their sexual behaviour and make them more permissive towards premarital sex, which is known to influence their academic performance. This can be modified by parental discussion on these matters with their children. There have been only few studies from India that have explored such issues therefore this study aimed to explore the impact of television, internet and parental discussion on sexual activity and academic performance.

METHODS

This study was conducted in two co-education schools using a self reporting questionnaire administered to students of class IX-XII. This study evaluated the relation of academic performance, exposure to media such as television & internet to sexual activity & academic performance of the students and the role of parental discussion on these.

RESULTS

The study sample size was 586. There is no significant association between the number of hours of watching television per day and academic performance as measured by marks in examinations. Significant positive association was found among boys between sexual contact and average score in academics & unsupervised use of internet. In both genders a significant positive association was found between those watching English serials, movies and increased chances of indulging in sexual activity while a negative relation with those watching Cartoons. There is no significant difference in occurrence of sexual contact in those who discussed sexual matters with parents and those who did not.

CONCLUSION

This being first of it's kind of study from India and a cross sectional study, further prospective and detailed studies are warranted to delineate the interaction of media, parental discussion, academic performance and sexual activity.

Optogenetics in psychiatry: The light ahead

Complexities of the human mind have been beyond the scope of understanding because a intricate neuronal network and difficulty in specific localization and assessment of area responsible for a specific behavior; more so in a freely moving living being. Optogenetics off late has been able to address this issue to great extent and holds promises for future. Relevant literatures in this direction were looked into and the salient aspects of this science is being discussed here with specific relevance to psychiatry.

A cross-sectional study of factors associated with adolescent sexual activity

CONTEXT

Adolescents constitute about 20% of our population and increasingly more of them are initiating sexual activity at an early age. Several behaviors associated with adolescence like masturbation, expression of masculinity/femininity, lifestyle habits like attending late night parties, and consumption of alcohol have been variously implicated in initiating sexual activities. Sexual abuse can also lead to premature sexualization. In view of few worthwhile studies from India that have dealt with these issues this study was undertaken.

AIMS

To elicit information from two co-education schools adolescent boys and girls on matters related to pubescence, sexual experiences, and sexual health.

SETTINGS AND DESIGN

Study subjects involved students from class IX to XII in two co-education schools. Consent of parents was taken to administer the questionnaire to their wards.

MATERIALS AND METHODS

A total of 586 out of 1580 students completed a self-reporting questionnaire on matters related to sexuality. Statistical Analysis EpiInfo6 Software was used.

RESULTS

Significant association was found among those holding the view that having sex proves their masculinity, being sexually abused, masturbation among boys, and sexual activity. A significantly large number of boys and girls are unaware of role of alcohol on sexual activity and that pregnancy can be caused by single intercourse.

CONCLUSIONS

This was probably the first such comparative study from India. Mechanisms need to be evaluated to help adolescents understand their sexual attitudes and situations that are likely to provoke sexual activity. Therefore, not only more detailed and longitudinal studies are needed to understand these relations in a better perspective, but also a well-planned educational program for adolescents is a need of the hour.

Partial Kluver-Bucy syndrome as a delayed manifestation of head injury

After traumatic brain injury (TBI), the most disabling problems are generally related to neuropsychiatric sequelae, including personality change and cognitive impairment, rather than neurophysical sequelae. Kluver-Bucy syndrome (KBS) is a rare neurobehavioral condition, first described in 1937 as an experimental neurobehavioral syndrome in monkeys with bitemporal brain lesions. The syndrome in man was subsequently observed to be transient or permanent in a variety of neurodegenerative disorders and after traumatic, nontraumatic and infectious brain injury. However, partial KBS may occur in the absence of the classic bilateral temporal lesion, though rare. Pharmacological treatment of post-TBI neuropsychiatric sequelae consists of symptomatic, functional and hypothetical approaches. Specific pharmacological treatment consists of antipsychotics, anti-kindling anticonvulsants or a combination thereof. A case of partial KBS presenting as delayed manifestation of traumatic brain injury that improved with carbamazapine and antipsychotics is presented.

Characterization of placental bikunin, a novel human serine protease inhibitor

We reported previously the cloning of a novel human serine protease inhibitor containing two Kunitz-like domains, designated as placental bikunin, and the subsequent purification of a natural counterpart from human placental tissue (Marlor, C. W., Delaria, K. A., Davis, G., Muller, D. K., Greve, J. M., and Tamburini, P. P. (1997) J. Biol. Chem. 272, 12202-12208). In this report, the 170 residue extracellular domain of placental bikunin (placental bikunin(1-170)) was expressed in baculovirus-infected Sf9 cells using its putative signal peptide. The resulting 21.3-kDa protein accumulated in the medium with the signal peptide removed and could be highly purified by sequential kallikrein-Sepharose and C18 reverse-phase chromatography. To provide insights as to the potential in vivo functions of this protein, we performed an extensive investigation of the inhibitory properties of recombinant placental bikunin(1-170) and both of its synthetically prepared Kunitz domains. All three proteins inhibited a number of serine proteases involved in the intrinsic pathway of blood coagulation and fibrinolysis. Placental bikunin(1-170) formed inhibitor-protease complexes with a 1:2 stoichiometry and strongly inhibited human plasmin (Ki = 0.1 nM), human tissue kallikrein (Ki = 0.1 nM), human plasma kallikrein (Ki = 0.3 nM) and human factor XIa (Ki = 6 nM). Conversely, this protein was a weaker inhibitor of factor VIIa-tissue factor (Ki = 1.6 microM), factor IXa (Ki = 206 nM), factor Xa (Ki = 364 nM), and factor XIIa (Ki = 430 nM). This specificity profile was to a large extent mimicked, albeit with reduced potency, by the individual Kunitz domains. As predicted from this in vitro specificity profile, recombinant placental bikunin(1-170) prolonged the clotting time in an activated partial thromboplastin time assay.

Alpha-factor leader sequence-directed transport of Escherichia coli beta-galactosidase in the secretory pathway of Saccharomyces cerevisiae

The construction of two fused genes is described. One involves the in-frame fusion of the yeast prepro-alpha-factor coding sequence, and the Escherichia coli lac Z gene. The second gene fusion utilizes a 103 bp yeast invertase NH2-terminal coding sequence at the fusion junction of the hybrid gene described above. The gene fusions, under the control of the alpha-factor promoter, expressed active beta-galactosidase in alpha haploid yeast cells. The activity could be regulated in a temperature-sensitive sir3 mutant. The incorporation of the invertase coding sequence at the MF alpha 1-lacZ fusion junction provided significantly higher levels of beta-galactosidase activity. A substantial quantity of the hybrid proteins generated from the gene fusions was primarily localized in the intracellular membranes of yeast cells, while a processed form could be secreted into the periplasm.

Dolichyldiphosphoryloligosaccharide--protein oligosaccharyltransferase; solubilization, purification, and properties

Dolichyldiphosphoryloligosaccharide-protein oligosaccharyltransferase was solubilized from hen oviduct rough endoplasmic reticulum by extraction with 0.2% Nonidet P40. Oligosaccharyltransferase activity was assayed in an incubation mixture containing Glc(n)-Man(x)-GlcNAc(2)-diphosphoryldolichol as an oligosaccharyl donor and the (125)I-labeled tryptic peptide consisting of residues 29-58 from bovine alpha-lactalbumin as acceptor. The transferase was purified approximately 2000-fold by fractionation on a bovine alpha-lactalbumin-Sepharose column; the active material bound quantitatively to the gel and was eluted by removal of divalent cation from the wash buffer. The product of the transferase activity, (125)I-glycopeptide, was determined as concanavalin A-agarose-adsorbed radioactivity by a filter disc assay method. (125)I-Labeled concanavalin A-agarose-bound product was characterized as a glycopeptide as follows: (i) gel filtration behavior on Sephadex G-50; (ii) elution from concanavalin A-agarose with 1% alpha-methyl mannoside; (iii) absence of affinity for ricin-Sepharose and loss of affinity for concanavalin A-agarose after treatment with endo-beta-N-acetylglucosaminidase H; (iv) enzymatic synthesis of identical product upon using [(3)H]oligosaccharyldiphosphoryldolichol and unlabeled peptide acceptor; and (v) digestion of (3)H-labeled peptide with Pronase, resulting in the formation of lower molecular weight glycopeptide. Oligosaccharyltransferase activity exhibited an absolute requirement for divalent cations (3 mM Mn(2+); Mg(2+) was 30% as effective), complete dependence on exogenously supplied peptide acceptor (1.33 mug/ml) and oligosaccharyldiphosphoryldolichol (approximately 10 nmol/ml), and an optimum pH between 7 and 7.5.

Occurrence of 3-hydroxyretinol in the freshwater fish Bagarius bagarius and Wallago attu. Isolation and synthesis

A new chromogen that absorbs maximally at 329 nm was frequently found in the liver oils of the freshwater fish Bagarius bagarius and Wallago attu. It was shown to be a diester of 3-hydroxyretinol. 3-Hydroxyretinol was found to be a metabolite of lutein during the biosynthesis of 3-dehydroretinol in a freshwater fish. A new method for the chemical synthesis of 3-hydroxyretinol from methyl 3-dehydroretinoate is described. The possible pathway for the conversion of lutein into 3-dehydroretinol in vivo is discussed.

Studies on the metabolism of beta-carotene and apo-beta-carotenoids in rats and chickens

(1)The relative abilities of the various fractions of rat and chicken liver to oxidize and reduce retinal and 8'-and 12'-apo-beta-carotenal were investigatjed and it has been shown that, while retinal is exclusely oxidized by the soluble fraction, the apocarotenals are mostly oxidized by the particulate fractions of the homogenate. (2) Addition of NAD+ or NADP+ markedly activated the oxidation of the apocarotenals, but not of retinal by the particulate fractions. (3) Considerable amounts of retinal and 8'-, 10'- and 12'-apo-beta-carotenal were isolated from the intestine of chickens fed beta-carotene and these apocarotenoids were conclusively identified. (4) Significant amounts of 8'-, 10'- and 12'-apo-beta-carotenoic acids were isolated from the intestine of rats given 8'-apo-beta-carotenal and these apocarotenoic acids were also conclusively identified. (5) In the light of these observations it is suggested that during conversion to vitamin A, the beta-carotene molecule is simultaneously attacked by the dioxygenase at several double bonds, the primary attack being at the central double bond and a tentative scheme for the mechanism of conversion is proposed.

Occurrence and conversion of anhydrolutein into dehydroretinol in a freshwater fish

1. Lutein and anhydrolutein have been isolated from liver oils of freshly caught Saccobranchus fossilis. 2. S. fossilis initially contained more dehydroretinol than retinol; administration of anhydrolutein to the vitamin A-depleted fish resulted in the accumulation of dehydroretinol. 3. Anhydrolutein has also been isolated from the liver oils of lutein-treated, vitamin A-depleted fish. 4. The pathway of the conversion of lutein into dehydroretinol is discussed.

Relationship between the preoptico hypophysial system and the vascular system in the teleost Rita rita (Ham.)

In Rita rita the internal carotid artery gives rise to hypothalamic and hypophysial arteries. The hypophysial artery directly enters the pituitary and largely contributes to the interface vasculature lying in between the neurohypophysis and the pars distalis which can be considered as an equivalent of the median eminence. Blood vessels from the interface vasculature enter the pars distalis. The hypothalamic artery gives rise to the primary capillary plexus in the infundibular floor and the portal vessels formed by it irrigate the glandular pituitary. Both, at the level of the hypothalamus and at the interface, neurosecretory material might get access to blood vessels. Thus, in Rita rita, not only the typical teleostean type of hypothalamo-hypophysial vascularization is present, but also an incipient tetrapodal pattern is evident.

Conversion of lutein into dehydroretinol by the freshwater fish, Saccobranchus fossilis

1. The vitamin A content ofSaccobranchus fossiliskept on a diet of rice and meat gradually decreased and became negligible at the end of 3–5 months.

2.S. fossilisinitially contained more dehydroretinol than retinol; administration of β-carotene or zeaxanthin to the vitamin A-depleted fish did not result in an accumulation of dehydroretinol in the liver. On the other hand, when lutein was administered by mouth or subcutaneous injection, it was converted into dehydroretinol.