Explanatory Models of Depression in a Rural Community of Coastal Karnataka, India: A Cross-Sectional Survey

BACKGROUND

Depression is a major public health problem but there is a huge treatment gap in India. Cultural beliefs influence conception of illness, personal meaning, help-seeking behaviors, and adherence to treatment. Research on explanatory models of depression attempt to explore these unique characteristics in an individual and the community. We set out to examine explanatory models of depression in a rural community of coastal Karnataka and explore the association between sociodemographic variables and explanatory models of depression.

METHODS

A cross-sectional household survey in the rural community of Harekala village, Mangaluru taluk, Dakshina Kannada district, Karnataka, was done using Kish tables. A total of 200 individuals were interviewed with an adaptation of the Short Explanatory Model Interview in a local language using a case vignette of depression.

RESULTS

Around 40% of the individuals perceived the problem as tension/stress/excessive worrying and did not perceive it as mental illness. A scant 10% of the participants recognized some mental illness. Around one-fifth of the individuals attributed the problem to evil spirits and black magic; female participants were more likely to endorse consulting a doctor (P = 0.003**) or a psychiatrist (P = 0.012*). In addition, participants belonging to Islam were less likely to consult a doctor (P = 0.028*) and psychiatrist (P = 0.021*). Also, participants belonging to lower social class were less likely to endorse psychiatric consultation (P = 0.018*).

CONCLUSIONS

A vast majority of the study subjects failed to identify depression as an illness or acknowledge biomedical causation. Gender, religion, and socioeconomic class may influence help-seeking behavior.

Development of a brief psychological intervention for perinatal depression (BIND-P)

BACKGROUND

Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND.

METHODS

A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit.

RESULTS

A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene).

CONCLUSION

The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.

Comparison of maternal stress and psychiatric morbidity among mothers of children having psychiatric disorders and those of typically developing children

INTRODUCTION

Motherhood is regarded to be stressful, but when the child has a psychiatric illness, the mother is affected more than the father since she is the primary caregiver. She gets affected not only emotionally but also psychologically. Increasing severity of stress in mothers may lead to negative outcome on a child's care.

AIMS

The aim of this study was to evaluate the stress levels in mothers of children diagnosed with psychiatric disorder and to study the association between children having a psychiatric disorder and the psychiatric morbidity in their mothers.

MATERIALS AND METHODS

This was a case-control study with a total of 150 participants, in which 75 consecutive mothers of children were diagnosed with any psychiatric illness using ICD-10 criteria and compared to 75 mothers of typically developing children. The study was approved by the Institutional Ethics Committee. The Parental Stress Scale and the Mini-International Neuropsychiatric Interview-Plus questionnaire were used for assessments.

RESULTS

The study showed statistically significant stress scores (49.54) in mothers having children diagnosed with psychiatric illnesses as compared to scores (30.98) in mothers of normally developing children. Psychiatric morbidity in cases (n = 58; 77.3%) was statistically significant as compared to controls (n = 23; 30.6%). Depression and anxiety were among the most common psychiatric morbidities evaluated, and the highest was for mothers having children with severe mental retardation.

CONCLUSION

In all children with psychiatric disorders, mothers have to be screened for psychiatric morbidity to prevent, detect, and manage it at the earliest.

Folie a deux in monozygotic twins with childhood trauma: A case report

Folie a deux is a rare syndrome characterized by induction of a delusion in a susceptible person in close proximity with an individual with known delusional disorder. We report a rare case of monozygotic twins with induced delusional disorder in one of the twins. The twins had experienced childhood trauma in the form of emotional neglect and physical abuse by the father. The primary case (Twin A) was diagnosed with delusional disorder and was treated with oral antipsychotic. The secondary case (Twin B) showed resolution of symptoms after separation from twin A. The case highlights the unique presentation of induced delusional symptoms in monozygotic twins and the close association between childhood trauma and psychosis.

Prevalence of depressive disorders among head-and-neck cancer patients: A hospital-based, cross-sectional study

BACKGROUND

Head-and-neck cancers (HNCs) are associated with significant psychosocial challenges at all stages of illness, which influence the course and outcome of cancer. We aimed to assess the prevalence of depressive disorders among patients with HNC and its sociodemographic and clinical determinants.

MATERIALS AND METHODS

It was a cross-sectional study conducted in the department of oncology of a medical college hospital from South India. A total of 100 adult patients with HNC were recruited over a period of 1 year, after obtaining ethical clearance. Mini International Neuropsychiatric Interview was used to assess for depressive disorders in these patients.

RESULTS

We found that 49% of the patients were suffering from major depressive disorder (MDD), 13% of the patients had MDD with melancholic features, and 10% had dysthymia. Functional impairment and surgical treatments were associated with the diagnosis of depressive disorders.

CONCLUSION

Depressive disorders are highly prevalent in HNC and emphasize the need for tailored psycho-oncological and psychotherapeutic interventions.

Arachnoid Cyst Causing Depression and Neuropsychiatric Symptoms: a Case Report

Arachnoid cysts are benign space-occupying brain lesions that contain cerebrospinal fluid. Most cases are congenital in origin, caused by failed fusion of the arachnoid membrane early in fetal development. Cases are often incidentally detected on neuroimaging; however, rarely patients present with neuropsychiatric manifestations when cysts expand and cause a midline shift, compression of nearby brain tissue or cerebrospinal fluid compartments or both. We report a case of a 56-year-old woman with no past history or family history of psychiatric illness who developed acute-onset right-sided weakness, depressive symptoms, and other neuropsychiatric deficits. A diagnosis of organic mood disorder caused by an arachnoid cyst was made. Her symptoms and neuropsychiatric deficits remitted after cyst marsupialisation by open craniotomy. Therefore, it is important to investigate the organic aetiology in elderly patients who present with simultaneous mood disorder and cognitive dysfunction.

Sensory Gating Deficits and their Clinical Correlates in Drug-Free/Drug-Naive Patients with Schizophrenia

BACKGROUND

Sensory gating refers to "filtering" of irrelevant sensory input in the brain. Auditory sensory gating deficit has been considered as a marker of schizophrenia (SCZ) and assessed using P50 paired-click paradigm. We explore sensory gating deficits and their clinical correlates in SCZ.

MATERIALS AND METHODS

Twenty-five drug-free/drug-naïve patients with SCZ, whose psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS), and 25 age-matched normal controls (NC) were recruited. ERP recordings were done using 40-channel event-related potential measuring system.

RESULTS

S2-S1 P50 amplitude difference, an index of sensory gating, was significantly lower in SCZ at F3 and F4 sites when compared to NC, indicating impaired gating. SCZ had significantly lower S1 amplitude compared to NC at these sites; S2 amplitudes were comparable. The sensory gating index also showed significant correlations with PANSS scores.

CONCLUSIONS

Our study reiterates sensory gating abnormalities in SCZ and confers a frontal specificity, implying specific deficits in early preattentive processes to them. Further, we suggest that gating deficits in SCZ are driven predominantly by abnormally small S1 rather than an inability to suppress S2. A correlation between sensory gating parameters and measures of psychopathology strengthens the hypothesis that abnormal response to sensory input may contribute to the psychopathology in SCZ.

Drinking pattern in persons with alcohol dependence with and without cirrhosis: A hospital-based comparative study

BACKGROUND

Worldwide, alcohol is the most frequently used and socially accepted hepatotoxin. However, not everyone who has alcohol dependence develops alcoholic cirrhosis, and does quantity/type or pattern of alcohol intake determine the development of cirrhosis? A study of this nature would help in delineating similarities/differences in the drinking pattern between alcohol dependence and alcohol-induced cirrhosis groups.

AIM

The aim was to study the drinking pattern of persons with alcohol dependence syndrome (ADS) and alcohol-induced cirrhosis.

MATERIALS AND METHODS

Alcohol Intake database and Severity of Alcohol Dependence Questionnaire (SADQ) were administered to eighty male inpatients with a reliable family member of which forty were in ADS group and forty were in alcohol dependence with cirrhosis group.

RESULTS

Persons in the cirrhosis group were older with longer duration of drinking. There is no statistically significant difference in the educational status, religion, occupation, socioeconomic class, mean age of onset of drinking, mean age of development of dependence, type of beverage preferred, and initiating/maintaining factors between the two groups. The amount of alcohol consumed was significantly high in the cirrhosis group, with 33.5% in the high severity of dependence. They usually were drinking alone, outside meal times with regular and intermittent binge pattern.

CONCLUSION

Alcohol dependence and alcohol-induced cirrhosis may be on a continuum but form a different group of heavy drinkers who may require different approaches to management.

Valproate: It's Effects on Hair

Valproate is a drug used in the treatment of various seizure disorders, bipolar disorder, migraine prophylaxis, and off label in many indications by various specialists. The common adverse drug reactions reported on valproate administration are tremor, weight gain, gastrointestinal disturbances, liver dysfunction, metabolic acidosis, thrombocytopenia, and hair loss. An internet search with keywords “valproate” and “hair” was done on Google Search and PubMed for articles related to the topic. Recognition of cosmetically significant side effects on hair is necessary and neglect of which might result in poor compliance. Valproate-induced hair loss is diffused, nonscarring, and dose related. Other hair-related adverse events are curling of hair, graying, dirty appearance, and changes in texture. In contrast to oral ingestions causing hair loss, experiments with topical valproic acid have shown some initial evidence on hair regeneration. This makes valproate's effects on hair interesting and understanding it's effects on hair is very much essential in clinical practice.

Facebook addiction and loneliness in the post-graduate students of a university in southern India

BACKGROUND

Facebook is a social networking site (SNS) for communication, entertainment and information exchange. Recent research has shown that excessive use of Facebook can result in addictive behavior in some individuals.

AIM

To assess the patterns of Facebook use in post-graduate students of Yenepoya University and evaluate its association with loneliness.

METHODS

A cross-sectional study was done to evaluate 100 post-graduate students of Yenepoya University using Bergen Facebook Addiction Scale (BFAS) and University of California and Los Angeles (UCLA) loneliness scale version 3. Descriptive statistics were applied. Pearson's bivariate correlation was done to see the relationship between severity of Facebook addiction and the experience of loneliness.

RESULTS

More than one-fourth (26%) of the study participants had Facebook addiction and 33% had a possibility of Facebook addiction. There was a significant positive correlation between severity of Facebook addiction and extent of experience of loneliness ( r = .239, p = .017).

CONCLUSION

With the rapid growth of popularity and user-base of Facebook, a significant portion of the individuals are susceptible to develop addictive behaviors related to Facebook use. Loneliness is a factor which influences addiction to Facebook.

Knowledge, attitude and anxiety pertaining to basic life support and medical emergencies among dental interns in Mangalore City, India

BACKGROUND

This cross-sectional study aimed to assess the knowledge, attitude and anxiety pertaining to basic life support (BLS) and medical emergencies among interns in dental colleges of Mangalore city, Karnataka, India.

METHODS

The study subjects comprised of interns who volunteered from the four dental colleges. The knowledge and attitude of interns were assessed using a 30-item questionnaire prepared based on the Basic Life Support Manual from American Heart Association and the anxiety of interns pertaining to BLS and medical emergencies were assessed using a State-Trait Anxiety Inventory (STAI) Questionnaire. Chi-square test was performed on SPSS 21.0 (IBM Statistics, 2012) to determine statistically significant differences (P<0.05) between assessed knowledge and anxiety.

RESULTS

Out of 183 interns, 39.89% had below average knowledge. A total of 123 (67.21%) reported unavailability of professional training. The majority (180, 98.36%) felt the urgent need of training in basic life support procedures. Assessment of stress showed a total of 27.1% participants to be above high-stress level. Comparison of assessed knowledge and stress was found to be insignificant (P=0.983).

CONCLUSION

There was an evident lack of knowledge pertaining to the management of medical emergencies among the interns. As oral health care providers moving out to the society, a focus should be placed on the training of dental interns with respect to Basic Life Support procedures.