COVID-19 has forced lockdowns and social distancing across the world. This has increased feelings... more COVID-19 has forced lockdowns and social distancing across the world. This has increased feelings of loneliness and reduced opportunities for physical exercise and environmental stimulation for the elderly. It was feared that all this would cause poor mental health in the elderly. However, well-designed studies reported that medically fit elderly and those without psychiatric comorbidities coped well with the pandemic. Cognitive flexibility, ability to regulate emotions and healthy lifestyle helped the elderly cope with this challenging situation. This article discusses the resilience measures used by the elderly to cope with the pandemic and make recommendations for use by the general population during the unprecedented situation caused by the COVID-19 pandemic.
Additional file 1. Supplement 1- Geographic distribution of home visits made and some representat... more Additional file 1. Supplement 1- Geographic distribution of home visits made and some representative photographs.
Breast cancer affects the mental well-being of patients who may need psychological support. The c... more Breast cancer affects the mental well-being of patients who may need psychological support. The combined practice of progressive muscle relaxation (PMR) and guided imagery (GI) is known to improve psychological health. Its effect has been studied in patients with breast cancer. We need to systematically review and analyse the available data to outline its role in various stages of disease management. We wanted to evaluate the effect of the combined practice of PMR and GI on stress, anxiety, depression and mood. We also wanted to study the impact on quality of life and chemotherapy-related adverse effects. A systematic search and evaluation of the literature was performed. Five randomised controlled trials were selected for data extraction and construction of forest plots. The intervention was effective for stress and anxiety. It positively improved the quality of life but saw no significant improvement in chemotherapy-related adverse effects.
Dissociative mutism is very rare in childhood. We present here a case of complete mutism of six m... more Dissociative mutism is very rare in childhood. We present here a case of complete mutism of six months duration in a seven-year-old male child. Normal neurological and otorhinolaryngological examination pointed towards psychological nature of the problem and warranted a psychiatric evaluation. Detailed psychiatric evaluation could identify the stressor and psychotherapy provided relief within a few days. Dissociative mutism in childhood, if identified and referred early for psychiatric evaluation, can reduce the distress and duration of dysfunction associated with the disorder. Besides, it can also reduce unnecessary investigations and burden on the health care system.
Screen media use by children has been a subject of constant concern by parents, teachers, pediatr... more Screen media use by children has been a subject of constant concern by parents, teachers, pediatricians, psychiatrists, and policymakers. The potential for its misuse often shadows media use in terms of its educational and communication opportunities. Adding to the concerns is that excessive screen media use is associated with poor physical and mental health. COVID-19 lockdowns, school closure, and online classes have increased media exposure to children. The prevailing risky situation has prompted global health agencies and professional societies to issue guidelines for safe media use. Parents in their day-to-day life grapple with the problem of knowing how much media is good are media addicting and how to regulate media use in their children. Whether working from home or on-site, working parents face more complex problems wherein their media use is known to shape the kids' screen media use. This viewpoint discussed the problem statement, and the possible solutions for the alre...
Context: Diabetes distress (DD) in India has been studied mainly in the context of depression. Li... more Context: Diabetes distress (DD) in India has been studied mainly in the context of depression. Little is known about DD, its determinants, distribution, and its impact. Aims: This study aims to estimate the prevalence of DD and identify its socio-demographic and clinical determinants in type 2 diabetes mellitus patients. To assess the relationship of DD with self-management in nondepressed type 2 diabetes mellitus. Settings and Design: A cross-sectional descriptive study in noncommunicable disease clinic of a tertiary care medical center. Subjects and Methods: DD Scale was used to assess DD in 200 patients with type 2 diabetes mellitus. Diabetes Self-Management Questionnaire was used to evaluate self-management behavior. Patient Health Questionnaire 9 was used to exclude depression. Statistical Analysis Used: Sample size calculation was done as per prevailing prevalence estimates. SPSS 20.0 was used for statistical analysis. ANOVA and Independent t-tests were done to compare between groups means. Hierarchical multiple regression analysis was done, keeping self-management as a dependent variable and socio-demographic, clinical variables, and DD as independent variables. Results: The prevalence of DD was 42% in our sample. The duration of diabetes showed that a significant association with DD. DD was significantly and negatively associated with all four domains of self-management, while statistical significance was reached in three domains: dietary control (β = −0.378, P < 0.01); glucose management (β = −0.181, P < 0.01); and healthcare use (β = −0.244, P < 0.01). Conclusions: DD is widespread in our patients and harms self-management. There is a need to address DD to improve disease-specific outcomes.
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
We thank Dr. Howland for his interest and thoughtful comments regarding our manuscript. Dr. Howla... more We thank Dr. Howland for his interest and thoughtful comments regarding our manuscript. Dr. Howland correctly shares the point that the brainstem may coordinate multiple sensory inputs, directing them to appropriate nodes throughout the cerebral cortex. We also acknowledge that it is conceivable that olanzapine’s effects on cholinergic neu rotransmission could have contributed to its therapeutic mechanism of action in our patient. Again, our thanks to Dr. Howland for further enhancing the quality of our manuscript.
Background Attention deficit hyperactivity disorder (ADHD) is a neuro-developmental ailment diagn... more Background Attention deficit hyperactivity disorder (ADHD) is a neuro-developmental ailment diagnosed with inattention and hyperactivity-impulsivity. It is one of the most prevalent neurodevelopmental disorders and has complex aetiology, both genetic and environmental. There is a perceived decrease in skill acquirement, leading to insufficient income and job opportunities as adults, which drives them towards poor physical and mental outcomes compared to their contemporaries without ADHD. The impact of heavy metals on ADHD is a topic of interest but is much less studied. Copper has been implicated as a pro-oxidant and in the metal accelerated production of free radicals that may affect oxidative stress. Zinc also serves as an antioxidant, and changes in its concentrations may impact the homeostasis of oxidative stress. Methods Twenty-four children diagnosed with ADHD were taken as cases and matched with 24 healthy controls. Hair and urine samples were collected from all the study participants. The samples were collected in sterile containers according to established protocols. Acid digestion of hair samples was done using 65% nitric acid and 30% hydrogen peroxide. Urine samples were extracted by a solution of 0.1% Triton-X-100 and 1% ultrapure nitric acid. The levels of zinc and copper were determined in both samples by inductively coupled plasma optical emission spectrometry (ICP-OES). The copper/zinc ratio (Cu/Zn) was calculated from these values. Mann Whitney U Test and receiver operating characteristic (ROC) analysis were done to estimate statistical significance. Results The median age of the study population was eight years. Overall, 34 male and 14 female subjects participated. There was no significant difference in height, weight and BMI between the cases and controls. Hair zinc levels in the ADHD group (198.49 µg g-1 of hair) was significantly lower than the control group (527.05 µg g-1 of hair). However, hair copper levels were increased significantly in the ADHD children (14.01 µg g-1 of hair) compared to the controls (7.43 µg g-1 of hair). Urine zinc levels were significantly lower in cases than controls (525.7 µg g-1 of spot urine creatinine vs 1374.09 µg g-1 of spot urine creatinine). However, copper levels in urine were higher in the ADHD children (17.01 µg g-1 of spot urine creatinine compared to 7.26 µg g-1 of spot urine creatinine in controls). Both hair and urine copper to zinc ratio was significantly higher in the ADHD group. On ROC analysis, the hair Cu/Zn ratio had an area under the curve (AUC) of 0.920 (p-value <0.001), and the urine Cu/Zn ratio had an AUC of 0.967 (p-value <0.001). When used as a diagnostic classifier for ADHD based on the cutoff value determined by ROC, both hair and urine Cu/Zn ratio had high sensitivity and specificity. Conclusion Low zinc levels in the urine and hair of children and higher levels of copper may impact the aetiology of ADHD in these children. At an early stage, the Cu/Zn ratio in both hair and urine samples may be used as a precise biomarker to identify and monitor such children.
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Introduction: Excessive cardiovascular reactivity to mental stress may be a risk factor for cardi... more Introduction: Excessive cardiovascular reactivity to mental stress may be a risk factor for cardiovascular disease. However, there is inconsistent report in the literature regarding change in cardiac autonomic tone with the phase of the menstrual cycle and how it is affected by mental stress. Therefore, the present study was aimed at determining the cardiovascular reactivity to different laboratory mental stressors during follicular and luteal phase of menstrual cycle using heart rate variability (HRV). Methods: Thirty-three regularly cycling young females (19-35 years of age) were exposed to four cognitive tasks (Stroop test, Mental Rotation test, n-back test, and Mental Arithmetic Stress Test [MAST]) employed as laboratory mental stressors. HRV of the study participants were recorded before, during, and after each cognitive task and the recording was done in both phases of menstrual cycle for each individual. Results: A significant difference was observed in time domain parameters and nonlinear parameters of HRV in pretest versus during-test condition and during-test versus post-test conditions, but not in frequency domain parameters. No phase difference was found in time domain or frequency domain analysis of HRV in baseline or during performance of task. MAST performance (score out of 50) was significantly higher in luteal than follicular phase, while other tests showed no such difference. Conclusion: All four mental stress tasks used in the present study were able to elicit significant decrease in parasympathetic tone during performance of task as compared with baseline values of HRV. The present study did not elicit any phase difference in cardiovascular reactivity.
Dermatitis artefacta, a self-inflicted intentional dermatosis is a very rare diagnosis in childho... more Dermatitis artefacta, a self-inflicted intentional dermatosis is a very rare diagnosis in childhood. In a large proportion, the underlying psychiatric disorders go unidentified due to lack of collaboration between dermatologist and psychiatrist. The underlying psychological reasons for childhood dermatitis artefacta include emotional distress and interpersonal conflicts. A multitude of psychosocial factors interact to precipitate this disorder. Here, we report a child with dermatitis artefacta who was diagnosed with attention deficit hyperactivity disorder during psychiatric evaluation. Parental expectations and sibling rivalry were further increasing the stress of the index child. Appropriate diagnosis and management lead to treatment compliance and functional improvement in the child.
COVID-19 has forced lockdowns and social distancing across the world. This has increased feelings... more COVID-19 has forced lockdowns and social distancing across the world. This has increased feelings of loneliness and reduced opportunities for physical exercise and environmental stimulation for the elderly. It was feared that all this would cause poor mental health in the elderly. However, well-designed studies reported that medically fit elderly and those without psychiatric comorbidities coped well with the pandemic. Cognitive flexibility, ability to regulate emotions and healthy lifestyle helped the elderly cope with this challenging situation. This article discusses the resilience measures used by the elderly to cope with the pandemic and make recommendations for use by the general population during the unprecedented situation caused by the COVID-19 pandemic.
Additional file 1. Supplement 1- Geographic distribution of home visits made and some representat... more Additional file 1. Supplement 1- Geographic distribution of home visits made and some representative photographs.
Breast cancer affects the mental well-being of patients who may need psychological support. The c... more Breast cancer affects the mental well-being of patients who may need psychological support. The combined practice of progressive muscle relaxation (PMR) and guided imagery (GI) is known to improve psychological health. Its effect has been studied in patients with breast cancer. We need to systematically review and analyse the available data to outline its role in various stages of disease management. We wanted to evaluate the effect of the combined practice of PMR and GI on stress, anxiety, depression and mood. We also wanted to study the impact on quality of life and chemotherapy-related adverse effects. A systematic search and evaluation of the literature was performed. Five randomised controlled trials were selected for data extraction and construction of forest plots. The intervention was effective for stress and anxiety. It positively improved the quality of life but saw no significant improvement in chemotherapy-related adverse effects.
Dissociative mutism is very rare in childhood. We present here a case of complete mutism of six m... more Dissociative mutism is very rare in childhood. We present here a case of complete mutism of six months duration in a seven-year-old male child. Normal neurological and otorhinolaryngological examination pointed towards psychological nature of the problem and warranted a psychiatric evaluation. Detailed psychiatric evaluation could identify the stressor and psychotherapy provided relief within a few days. Dissociative mutism in childhood, if identified and referred early for psychiatric evaluation, can reduce the distress and duration of dysfunction associated with the disorder. Besides, it can also reduce unnecessary investigations and burden on the health care system.
Screen media use by children has been a subject of constant concern by parents, teachers, pediatr... more Screen media use by children has been a subject of constant concern by parents, teachers, pediatricians, psychiatrists, and policymakers. The potential for its misuse often shadows media use in terms of its educational and communication opportunities. Adding to the concerns is that excessive screen media use is associated with poor physical and mental health. COVID-19 lockdowns, school closure, and online classes have increased media exposure to children. The prevailing risky situation has prompted global health agencies and professional societies to issue guidelines for safe media use. Parents in their day-to-day life grapple with the problem of knowing how much media is good are media addicting and how to regulate media use in their children. Whether working from home or on-site, working parents face more complex problems wherein their media use is known to shape the kids' screen media use. This viewpoint discussed the problem statement, and the possible solutions for the alre...
Context: Diabetes distress (DD) in India has been studied mainly in the context of depression. Li... more Context: Diabetes distress (DD) in India has been studied mainly in the context of depression. Little is known about DD, its determinants, distribution, and its impact. Aims: This study aims to estimate the prevalence of DD and identify its socio-demographic and clinical determinants in type 2 diabetes mellitus patients. To assess the relationship of DD with self-management in nondepressed type 2 diabetes mellitus. Settings and Design: A cross-sectional descriptive study in noncommunicable disease clinic of a tertiary care medical center. Subjects and Methods: DD Scale was used to assess DD in 200 patients with type 2 diabetes mellitus. Diabetes Self-Management Questionnaire was used to evaluate self-management behavior. Patient Health Questionnaire 9 was used to exclude depression. Statistical Analysis Used: Sample size calculation was done as per prevailing prevalence estimates. SPSS 20.0 was used for statistical analysis. ANOVA and Independent t-tests were done to compare between groups means. Hierarchical multiple regression analysis was done, keeping self-management as a dependent variable and socio-demographic, clinical variables, and DD as independent variables. Results: The prevalence of DD was 42% in our sample. The duration of diabetes showed that a significant association with DD. DD was significantly and negatively associated with all four domains of self-management, while statistical significance was reached in three domains: dietary control (β = −0.378, P < 0.01); glucose management (β = −0.181, P < 0.01); and healthcare use (β = −0.244, P < 0.01). Conclusions: DD is widespread in our patients and harms self-management. There is a need to address DD to improve disease-specific outcomes.
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
We thank Dr. Howland for his interest and thoughtful comments regarding our manuscript. Dr. Howla... more We thank Dr. Howland for his interest and thoughtful comments regarding our manuscript. Dr. Howland correctly shares the point that the brainstem may coordinate multiple sensory inputs, directing them to appropriate nodes throughout the cerebral cortex. We also acknowledge that it is conceivable that olanzapine’s effects on cholinergic neu rotransmission could have contributed to its therapeutic mechanism of action in our patient. Again, our thanks to Dr. Howland for further enhancing the quality of our manuscript.
Background Attention deficit hyperactivity disorder (ADHD) is a neuro-developmental ailment diagn... more Background Attention deficit hyperactivity disorder (ADHD) is a neuro-developmental ailment diagnosed with inattention and hyperactivity-impulsivity. It is one of the most prevalent neurodevelopmental disorders and has complex aetiology, both genetic and environmental. There is a perceived decrease in skill acquirement, leading to insufficient income and job opportunities as adults, which drives them towards poor physical and mental outcomes compared to their contemporaries without ADHD. The impact of heavy metals on ADHD is a topic of interest but is much less studied. Copper has been implicated as a pro-oxidant and in the metal accelerated production of free radicals that may affect oxidative stress. Zinc also serves as an antioxidant, and changes in its concentrations may impact the homeostasis of oxidative stress. Methods Twenty-four children diagnosed with ADHD were taken as cases and matched with 24 healthy controls. Hair and urine samples were collected from all the study participants. The samples were collected in sterile containers according to established protocols. Acid digestion of hair samples was done using 65% nitric acid and 30% hydrogen peroxide. Urine samples were extracted by a solution of 0.1% Triton-X-100 and 1% ultrapure nitric acid. The levels of zinc and copper were determined in both samples by inductively coupled plasma optical emission spectrometry (ICP-OES). The copper/zinc ratio (Cu/Zn) was calculated from these values. Mann Whitney U Test and receiver operating characteristic (ROC) analysis were done to estimate statistical significance. Results The median age of the study population was eight years. Overall, 34 male and 14 female subjects participated. There was no significant difference in height, weight and BMI between the cases and controls. Hair zinc levels in the ADHD group (198.49 µg g-1 of hair) was significantly lower than the control group (527.05 µg g-1 of hair). However, hair copper levels were increased significantly in the ADHD children (14.01 µg g-1 of hair) compared to the controls (7.43 µg g-1 of hair). Urine zinc levels were significantly lower in cases than controls (525.7 µg g-1 of spot urine creatinine vs 1374.09 µg g-1 of spot urine creatinine). However, copper levels in urine were higher in the ADHD children (17.01 µg g-1 of spot urine creatinine compared to 7.26 µg g-1 of spot urine creatinine in controls). Both hair and urine copper to zinc ratio was significantly higher in the ADHD group. On ROC analysis, the hair Cu/Zn ratio had an area under the curve (AUC) of 0.920 (p-value <0.001), and the urine Cu/Zn ratio had an AUC of 0.967 (p-value <0.001). When used as a diagnostic classifier for ADHD based on the cutoff value determined by ROC, both hair and urine Cu/Zn ratio had high sensitivity and specificity. Conclusion Low zinc levels in the urine and hair of children and higher levels of copper may impact the aetiology of ADHD in these children. At an early stage, the Cu/Zn ratio in both hair and urine samples may be used as a precise biomarker to identify and monitor such children.
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Introduction: Excessive cardiovascular reactivity to mental stress may be a risk factor for cardi... more Introduction: Excessive cardiovascular reactivity to mental stress may be a risk factor for cardiovascular disease. However, there is inconsistent report in the literature regarding change in cardiac autonomic tone with the phase of the menstrual cycle and how it is affected by mental stress. Therefore, the present study was aimed at determining the cardiovascular reactivity to different laboratory mental stressors during follicular and luteal phase of menstrual cycle using heart rate variability (HRV). Methods: Thirty-three regularly cycling young females (19-35 years of age) were exposed to four cognitive tasks (Stroop test, Mental Rotation test, n-back test, and Mental Arithmetic Stress Test [MAST]) employed as laboratory mental stressors. HRV of the study participants were recorded before, during, and after each cognitive task and the recording was done in both phases of menstrual cycle for each individual. Results: A significant difference was observed in time domain parameters and nonlinear parameters of HRV in pretest versus during-test condition and during-test versus post-test conditions, but not in frequency domain parameters. No phase difference was found in time domain or frequency domain analysis of HRV in baseline or during performance of task. MAST performance (score out of 50) was significantly higher in luteal than follicular phase, while other tests showed no such difference. Conclusion: All four mental stress tasks used in the present study were able to elicit significant decrease in parasympathetic tone during performance of task as compared with baseline values of HRV. The present study did not elicit any phase difference in cardiovascular reactivity.
Dermatitis artefacta, a self-inflicted intentional dermatosis is a very rare diagnosis in childho... more Dermatitis artefacta, a self-inflicted intentional dermatosis is a very rare diagnosis in childhood. In a large proportion, the underlying psychiatric disorders go unidentified due to lack of collaboration between dermatologist and psychiatrist. The underlying psychological reasons for childhood dermatitis artefacta include emotional distress and interpersonal conflicts. A multitude of psychosocial factors interact to precipitate this disorder. Here, we report a child with dermatitis artefacta who was diagnosed with attention deficit hyperactivity disorder during psychiatric evaluation. Parental expectations and sibling rivalry were further increasing the stress of the index child. Appropriate diagnosis and management lead to treatment compliance and functional improvement in the child.
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