Psychological ventilator dependence: A case report

Abstract Weaning a patient off mechanical ventilation, especially when they have been dependent on it for a long time, can be a difficult task. Many physical and psychological factors contribute towards dependence on the ventilator. We re-. port a case of a 28-year-old female patient that developed anxiety and a psychological dependence on the ventilator thereby making weaning off difficult. Timely psychiatric intervention resulted in successful weaning off the ventilator

Electroconvulsive in a 75-year-old patient with severe agitated behavior and dementia

Various drugs have been used in the management of behavioral and psychotic symptoms including aggression and agitation in dementia. However, the risk of side effects and sedation limits the use of higher doses of many agents. Electroconvulsive therapy (ECT) has been used in the management of behavioral symptoms related to dementia although sparingly and rare. We report the case of a 75.year.old male patient with moderate Alzheimer's dementia and severe agitated behavior and aggression which failed to respond to pharmacological treatment and whom we treated using seven ECT sessions with success. Significant clinical improvement was noted and no cognitive decline or worsening of the dementia in any form was reported. The patient was followed up 6 months post the ECT sessions. This case report demonstrates the safety and efficacy ECT use patients with Alzheimer's dementia when behavioral problems and aggression or agitation fail to respond to medications

Psychometric properties of indian disability evaluation and assessment scale in the patients of schizophrenia

Background: The assessment of disability is an integral part of the management of patients with schizophrenia. The Indian Disability Evaluation and Assessment Scale (IDEAS) is a government-recommended tool used for the assessment and certification of disability in mental illnesses. The literature on the psychometric properties such as reliability and validity of IDEAS for the assessment of disability in schizophrenia patients is relatively scant. Materials and Methods: This was a cross-sectional, observational, descriptive study done in a tertiary health care center catering the rural patients in central India. A hundred male and female treatment-seeking schizophrenia patients, who were in symptom remission, were purposively included in the study. Apart from sociodemographic profile and severity assessment, the disability levels of the patients were assessed using IDEAS as well as the World Health Organisation Disability Assessment Scale version 2.0 (WHODAS 2.0). Results: The mean age of the patients included in the study was 36.6 (±9.11) years. Among the four disability domains in the IDEAS, maximum disability was seen in the work domain, whereas self-care was the least affected domain. Males had a higher disability in work, whereas in the individuals belonging to joint families and rural backgrounds, self-care was significantly affected. Pearson correlation test implied that IDEAS showed good internal consistency (Cronbach's alpha = 0.892) and concurrent validity with the WHODAS 2.0 in the assessment of disability in the study participants. Conclusion: IDEAS is a reliable and valid instrument for the measurement of disability in severe mental illnesses such as schizophrenia

Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

Background: Electroconvulsive therapy (ECT) is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years) had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26%) showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly

FORMULATION AND DEVELOPMENT OF MUCOADHESIVE NASAL DRUG DELIVERY OF ROPINIROL HCL FOR BRAIN TARGETING

Objective: The purpose of this research was to create polymeric nanoparticles of Ropinirole HCl for nasal administration utilising the ionic gelation process. Methods: The preparation method was optimized using Box-Behnken design employing chitosan concentration, guar gum concentration and surfactant concentration as independent variables were as Encapsulation efficiency and mucoadhesion of the formulation were selected as dependent variables. Differential scanning calorimetry and infrared spectroscopy analysis of the drug and polymers revealed that the drug and excipients are physicochemically compatible. Studies on entrapment efficiency, drug content, and In-vitro release were conducted on the nanoparticles. Results: Each formulation was determined to have a drug content of between 60% and 70% and an entrapment efficiency of between 65% and 84%.In-vitro drug release tests demonstrated that Ropinirole HCl will release between 65 and 81 percent after 5 hours. Conclusion: The results showed that the particle size, encapsulation effectiveness, and drug content were all significantly affected by the amounts of chitosan and guar gu

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial

BackgroundLow- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. ObjectiveThis study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women’s self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. MethodsThe proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. ResultsWe will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. ConclusionsThis study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial RegistrationClinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN International Registered Report Identifier (IRRID)DERR1-10.2196/4245