COVID-19 PANDEMIC AND THE PROVISION FOR ELECTROCONVULSIVE THERAPY AND OTHER NON-INVASIVE BRAIN STIMULATION IN INDIA: A TEMPLATE FOR FUTURE PANDEMICS

The coronavirus disease (COVID-19) has emerged as a major public health concern worldwide. While containing the infection and caring for the ill has been a focus over the last 2 years, there has also been a burgeoning concern for mental health issues during this never-ending pandemic. The focus of health care machinery prioritized confronting and containing the pandemic that had majorly side-lined other aspects of public health. This also impacted persons with mental illness (PMI) requiring Electroconvulsive Therapy (ECT), an often essential and life-saving treatment and thus an essential procedure. ECT and other non-invasive brain stimulation (NIBS) services have seen a setback during this pandemic both in terms of its accessibility by the PMI and in effectively delivering its benefits by psychiatrists. In this article, we will be discussing the problems with provision and delivery of ECT services as well as other NIBS during this pandemic with a brief outline on the solutions for such with special focus on a developing country like India. This article will also endeavour in providing a roadmap in the delivery and provision of NIBS modalities of therapy for future pandemics, if any

School refusal, depression and suicidality in an adolescent girl- the interplay of stress and vulnerability: a case report

The stress vulnerability model emphasizes the interplay of genetic vulnerability, personal characteristics and psychosocial factors in the causation of mental illness. The index case highlights the genesis of psychiatric illness in an adolescent female with a family history of bipolar disorder and substance dependence leading to impaired family interaction and family dynamics. Individual psychotherapy, family therapy and pharmacological management proved beneficial in the index case

Treatment resistant psychosis in children and adolescents and clozapine: Nuances

With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group

Level of physical activity and its relationship with tobacco use among youth: a cross-sectional survey in North India

Background: Tobacco use and physical inactivity are major risk factors for NCDs. Adequate physical activity keeps one healthy but sedentary life style may contribute to other unhealthy practices like tobacco use. There is a need to identify if and how the two risk factors are interrelated so as to address them more strategically. Objectives: To assess the level of physical activity and to identify its association with tobacco use among college going youth in Chandigarh. Material & Methods: Data on physical activity and tobacco use was collected from 500 students aged 18-24 years studying in different professional and nonprofessional colleges of Chandigarh in year, through a multistage stratified random sampling technique. We used semi-structured, self-administered questionnaires-namely 78 item Global Adult Tobacco Survey (GATS) for assessing tobacco use status and GPAQ (Global Physical Activity Questionnaire) for assessment of physical activity. Binary logistics regression analysis was done to find association between tobacco use and physical activity. Odd’s ratio & 95% confidence interval (C.I.) was calculated. Results: Of the 500 individuals studied, 12.8% (n=64) were physically inactive, 10% (n=50) were active and 76.2% (n=381) were highly active. Females (15.8%) were more inactive as compared to males (12.1%). Highly active respondents were seen more in 18-20 years age group (77.6%) as compared to 21-22 years age group (76.1%). The odds of consuming tobacco is significantly lower  among physically active respondents as compared to inactive respondents. Conclusions: Our findings indicate a significant relationship between physical activity and tobacco use among youth. Promotion of physical activity may be a useful educational tool for reducing tobacco use

Physical activity level and its relationship with tobacco use among youth: a cross-sectional survey in North India

Background Tobacco use and physical inactivity are major risk factors for NCDs. Adequate physical activities keep one healthy but sedentary life style may contribute to other unhealthy practices. There is a need to identify if and how the two risk factors are interrelated so as to address them more strategically. Thus, the present study was undertaken to assess the level of physical activity and to identify its association with tobacco use among college going youth in Chandigarh. Methods Data on physical activity and tobacco use was collected from 500 students aged 18-24 years studying in different professional and nonprofessional colleges of Chandigarh during June- July 2015, through multistage simple random sampling using a self-administered questionnaire. Results The study findings indicated 12.8% (n=64) were inactive, 10% (n=50) were active and 76.2% (n=381) were highly active out of the 500 individuals. Females (15.8%) were more inactive as compared to males (12.1%). Highly active respondents were seen more in 18-20 years age group (77.6%) as compared to 20-22 years age group (76.1%). In regard to relationship between physical activity and tobacco use status of the respondents in study population, it was observed that odds of consuming tobacco is significantly 0.48 times lower in active respondents as compared to inactive respondents (p value < 0.05). Conclusions NCDs are emerging as a big threat among youth. Our findings indicate a significant relationship between physical activity and tobacco use among youth. (OR= 0.48; p< 0.05) Thus, promoting physical activities may be a useful educational tool for reducing tobacco use

ONE FLEW OVER THE CUCKOO\u27S NEST: THE CHRONICLES OF STIGMA AND A PROPOSED SOCIO-COGNITIVE-EMOTIONAL-BEHAVIORAL MODEL FOR UNDERSTANDING ITS GENESIS IN COVID-19

Stigma is a convoluted interaction between history, sociology, psychology, medicine, anthropology, and politics. Often, stigma is inter-twined at cognitive-emotional-behavioral level with a socio-cultural-economic-political milieu and hence distinct from prejudice, discrimination or, stereotypy. Stigma against diseases as a concept has evolved and has differed among various illnesses. At this time of humanitarian crisis, it is prudent to understand the concept, elements and models of stigma to tackle stigma against COVID-19 instrumentally. Stigma against COVID-19 can be partially extrapolated from various models described in psychiatry for mental illness. We propose an integrated socio-cognitive-emotional-behavioral model of stigma to conceptualize and understand the stigma against COVID-19, a matter of immense public health significance

Psychological co-morbidity in children with specific learning disorders

Children under 19 years of age constitute over 40% of India′s population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs) exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder) is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common) to depression, anxiety, suicide etc., to substance abuse (least common). Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most) given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind