Biomedical journal editors often encounter manuscripts claiming that ethics review or participant consent was unnecessary because the studies were low risk or did not involve patients. Such claims may reflect misunderstandings of contemporary research ethics. Ethical responsibilities extend to research involving human participants, identifiable data, biological materials, and digital or online settings. Exemption from ethics review and waiver or modification of informed consent are distinct decisions that should be made in accordance with applicable regulations and, where required, determined by an ethics committee rather than the investigator alone. This article examines four common misconceptions and provides practical guidance for clear ethics statements in biomedical manuscripts.
Background: Phonemic awareness deficits are a core feature of specific learning disorder with impairment in reading (SLD-R) in alphabetic languages. How task- and language-specific factors influence these deficits in alphasyllabary languages may help clarify the cognitive mechanisms underlying reading impairment in SLD-R. Methods: Thirty children with SLD-R (mean age 11.4 years) and 29 age-matched typically developing children were given phoneme blending (words and pseudowords) and segmentation tasks in Malayalam, an alphasyllabary language. Results: Children with SLD-R performed significantly worse than controls across most phonemic awareness tasks, with the largest deficits observed in pseudoword blending and word blending, and smaller deficits in segmentation. In typically developing children, age showed strong positive correlations with phonemic performance across most tasks. In contrast, the SLD-R group showed weak or absent correlations, except in word blending and initial phoneme deletion. Consonant clusters significantly affected performance in both groups, with SLD-R showing more severe deficits. Conclusions: Phonemic awareness deficits observed in SLD-R in Malayalam are more pronounced in tasks lacking lexical support, such as pseudoword blending. These deficits vary across task types and linguistic complexity. The findings suggest that phonemic awareness deficits are a core feature of SLD-R across languages, but orthographic, and linguistic characteristics of the writing system shape their manifestation.
Background:Surpassing the global and Bangladesh averages, Jhenaidah, a southwestern region in Bangladesh, remains one of the most prone districts for suicidal ideation and suicide rates. However, despite the higher prevalence, there is no psychometric measure available to assess the degree of suicidal ideation in this region. The present study aimed to validate the Bangla version of the Suicidal Ideation Scale (B-SIS) in Jhenaidah. Methods:We recruited 300 participants (male 50.87% and female 45.13%) via purposive sampling from six sub-districts, with an overall mean age of 23.26 (SD = 2.96). We used the B-SIS, the World Health Organisation-5 Well-being Index and the Symptom Rating Scale. Results:The scale yielded a one-factor structure with 55.58% of the total variance supported by multiple indices in confirmatory factor analysis (RMSEA = 0.061, CFI = 0.981, TLI = 0.971, SRMR = 0.035). The intraclass correlation coefficient (two-way random-effects model, absolute agreement) for average measures was 0.90 (95% CI, [0.84, 0.95]; F[29, 551] = 10.11; p < .001), indicating high score stability across administrations. The scale also demonstrated acceptable internal consistency, reliability and construct validity. Conclusions:The psychometric properties suggest that the B-SIS is a suitable measure to assess suicidal ideation in Jhenaidah. The study is expected to advance scholarly work in suicidology by taking Jhenaidah into account.
Developmental dyslexia is typically identified during childhood, but some individuals remain undiagnosed until adulthood, particularly when intellectual functioning is average, and compensatory strategies allow academic progression. In such cases, literacy-related inefficiencies may become clinically significant when occupational or interpersonal demands increase, leading to anxiety, avoidance, and functional impairment. This report describes a 26-year-old male presenting with longstanding reading and writing difficulties associated with marked anxiety during written communication and interpersonal conflict. Assessment revealed average intellectual functioning with reduced processing speed, persistent literacy-related deficits across reading, spelling, writing, and phonological processing domains, along with moderate anxiety symptoms. Findings were considered suggestive of developmental dyslexia with secondary anxiety-related difficulties. Treatment was based on a formulation-driven, integrative approach combining cognitive-behavioral therapy, functional analysis, compensatory skill training, graded exposure, and interpersonal interventions. Therapy focused on reducing avoidance, improving efficiency in literacy-dependent tasks, and addressing maladaptive beliefs related to performance. Following the intervention, anxiety severity decreased, engagement in written communication improved, and interpersonal difficulties reduced. This case highlights the clinical usefulness of an integrative, formulation-based psychotherapy approach in adults with previously unrecognized dyslexia. It emphasizes the importance of addressing both neurodevelopmental vulnerabilities and secondary emotional responses.
Post-traumatic stress disorder (PTSD) often follows a chronic trajectory, with many patients failing to respond to first-line psychotherapy and SSRIs/SNRIs. This case series explores clozapine for treatment-resistant PTSD (TR-PTSD) without psychosis. Seven soldiers showed improved function and reduced aggression at doses of 125-300 mg, suggesting that clozapine warrants further investigation.
Background:Metabolic syndrome (MS) significantly contributes to premature mortality in schizophrenia, which is driven by multiple biological and behavioral factors. While individual risk factors are known, comprehensive studies examining the combined influence of biological markers (adiponectin) and behavioral factors (sleep, lifestyle) in the Indian context are limited. Methods:In this cross-sectional, observational study, 130 patients diagnosed with schizophrenia were assessed for MS using modified National Cholesterol Education Program Adult Treatment Panel III criteria. We evaluated symptom severity using the Brief Psychiatric Rating Scale, Sleep quality using the Pittsburgh Sleep Quality Index, and lifestyle behaviors using the Health-Promoting Lifestyle Profile-II. Blood samples were analyzed for serum adiponectin and metabolic profiles to diagnose MS. Results:The MS rate was 24.6%. Bivariate analyses revealed that patients with MS had a significantly longer time spent in exacerbation (p = .03), a longer treatment duration (p = .01), lower serum adiponectin levels (p = .02), poorer sleep quality (p = .001), and lower physical activity and nutritional habit scores (p = .01). In the multivariable logistic regression model, poorer sleep quality (OR = 1.17, 95% CI = 1.06-1.30, p = .002) and a lower physical activity and nutritional habit score (OR = 0.92, 95% CI = 0.86-0.98, p = .01) emerged as significant predictors of MS. Conclusions:One-fourth of the patients with schizophrenia had MS in this cohort. Notably, modifiable behavioral factors-specifically sleep quality and lifestyle-were stronger predictors of metabolic risk. This signifies the vital need to integrate routine screening for cardiometabolic risk factors and to apply therapeutic strategies into the standard of care for schizophrenia.
Latent variables, such as depression and anxiety, are measured using questionnaires, making appropriate scoring essential. This article examines the Standardized Index Score (0-100), a simple equal weighting method widely used with Likert scales. It discusses the method's rationale, applications, advantages, and limitations for psychological measurement and scale development.
Background: Second-generation antipsychotics (SGAs), widely used in the management of schizophrenia, have significant side effects like daytime sedation and metabolic derangement. Betahistine (H1 agonist) has shown promising results for metabolic parameters and is less studied for the management of daytime sedation. Objectives: This study aims to evaluate the effect of Betahistine on daytime sedation and metabolic parameters in patients with schizophrenia on SGAs from baseline to 6 weeks. Methods: This open-label randomized control trial will recruit 76 participants (Purposive sampling) aged >18 years, any gender, with a diagnosis of Schizophrenia on SGAs at AIIMS Bibinagar. Participants will be assessed for daytime sedation using the Epworth Sleepiness Scale (ESS) and for metabolic derangement using blood investigations and body measurements. Participants will be randomly allocated (via opaque, sealed envelopes) to two groups. Group 1 will receive Betahistine and treatment as usual, and Group 2 will receive treatment as usual (existing antipsychotics). Participants in both groups will be followed up at 2, 4, and 6 weeks. Expected outcome: Changes in daytime sedation will be assessed using ESS scores at each follow-up at 2, 4, and 6 weeks. Changes in metabolic parameters will be assessed using blood investigations and body measurements at baseline and 6 weeks.
Background: Decision-making regarding inpatient hospitalization in the emergency care setting is complex and depends on several factors that have been poorly studied. A better understanding of the impact of subjective and objective factors on decision-making is a clear clinical need. This article explored the factors influencing psychiatrists’ decision-making regarding emergency room admission across various situations. Methods: This study used an exploratory qualitative research design. Focus group discussions, centered on case vignettes, were held with psychiatry trainees and licensed psychiatrists. These were audio-recorded with the participants’ permission, transcribed, coded, and later analyzed using thematic analysis. Results: Five themes emerged (prioritizing patient safety by risk assessment, institution-related factors, resource constraints, clinician-related factors, and the role of family). These themes highlighted the relevant situational factors that influence decision-making regarding hospitalization, in addition to the presence of clinical risk. Conclusion: Indian psychiatrists do not base decisions regarding admissions to the emergency room on clinical assessments alone. They are cognizant of various contextual, social, and cultural factors as they navigate competing ethical imperatives.
Background:Mental health experts commonly rely on subjective interviews and resource-intensive projective tools to assess adolescent mental health problems. A validated Hindi version of the depression, anxiety, and stress scale for youth-21-item (DASS-Y-21) remains unavailable for the Indian adolescent population. Methods:The present study aimed to translate and validate DASS-Y-21 into Hindi among juvenile delinquents in India. The study complied with COnsensus-based Standards for the selection of health measurement instruments and STrengthening the Reporting of OBservational studies in Epidemiology guidelines for reporting findings. This study utilized a cross-sectional design with purposive sampling to study 351 Hindi-speaking male juvenile delinquents within the age range of 10-19 years from two detention centers across Delhi, India. The analysis was conducted in four stages: (a) descriptive statistics, (b) reliability testing, (c) confirmatory factor analysis (CFA), and (d) Rasch analysis. Results:All recruited participants were males with a mean age of 16.3 (±1.18) years. Descriptive and normality analysis suggested higher variability in the data. The item-rest correlations ranged from moderate to high levels. Item drop test revealed Cronbach's (α) and McDonald's (ω) values > 0.90. In CFA, the comparative fit index, Tucker-Lewis index, standardized root mean square residual, and root mean square error of approximation, the model showed good fit. The rating scale method (RSM) had a lower log-likelihood value (-7,989) than the partial credit model (PCM) (-7,870). CFA confirmed the good fit of the 3-factor model of DASS-Y among Indian Hindi-speaking juvenile delinquents. In Rasch analysis, PCM indicated moderate difficulty for the items. Conclusion:The study translated DASS-Y-21 into Hindi and evaluated its psychometric properties among Indian juvenile delinquents. Reliability tests confirm good internal consistency. Both PCM and RSM models demonstrated adequate fit with slight differences in log-likelihood values.
India's counseling psychology landscape features a mix of regulated professionals and supervised lay counselors in task-sharing models, alongside unregulated practice by unqualified individuals offering psychotherapy via online platforms and short courses amid a large treatment gap in mental health services. While supervised lay counselors play a constructive role in evidence-based task-sharing under specialist oversight, unregulated practice risks inconsistent quality and client harm. Statutory title protection, tiered workforce models, and enforcement against deceptive mental health services are urgently needed in India.
Background: Despite a high burden of psychological issues in low- and middle-income sub-Saharan countries, no national-level assessment exists for Senegal.Methods: To assess the prevalence and predictors of psychological issues, we analyzed the 2023 Senegal Demographic and Health Survey (DHS) data from 75,080 household members.Results: The prevalence of psychological issues in Senegal was 5% (95% CI = 5.2-5.6). It was highest in the Matam region (8.7%) and lowest in the Saint-Louis region (3.5%). Female gender (adjusted odds ratios [aOR] = 1.11, 95% CI = 1.02-1.22), no education (aOR = 1.24, 95% CI = 1.11-1.36), singlehood (aOR = 1.64, 95% CI = 1.46-1.85), owned housing (aOR = 1.52, 95% CI = 1.26-1.84), rural residency (aOR = 1.18, 95% CI = 1.05-1.32), higher household size (aOR = 1.01, 95% CI = 1.01-1.02), indoor second-hand smoke (SHS) (aOR = 1.57, 95% CI = 1.43-1.73), and shock events (aOR = 1.61, 95% CI = 1.48-1.76) increased the likelihood of psychological issues. Access to video players (aOR = 0.22, 95% CI = 0.12-0.41), mobile phones (aOR = 0.77, 95% CI = 0.68-0.87), and the internet (aOR = 0.79, 95% CI = 0.66-0.96) reduced the likelihood of psychological issues.Conclusions: The burden of psychological issues is high in Senegal. Socio-demographic predictors suggest higher vulnerability among females, the uneducated, unmarried, and rural residents. Stressors such as shock events and indoor SHS increase the risk of psychological issues among household members. Access to recreational tools such as video players, mobiles, and the internet is beneficial in reducing psychological issues. Policy reforms prioritizing strategies to reduce psychological issues and integrating mental health services into healthcare delivery are discussed and recommended.
Background: Pilot studies are essential for assessing feasibility and operational processes before large-scale research. This study presents a Poisson-based framework for determining the minimum pilot sample size based on discrete event thresholds. Methods: The number of events represents occurrences such as errors, deviations, or missing data that indicate whether a process is functioning as intended. Setting a maximum tolerable threshold for these events provides a clear decision rule for proceeding or refining study procedures. A Poisson-based model was applied for sample size calculation. Results: Based on α ≤ 0.05, the findings show that sample sizes vary depending on the study conditions, namely the maximum tolerable threshold and event rate. Sample size increases with the number of thresholds, while other parameters remain fixed. When α ≤ 0.05, sample sizes ranging from 12 to 26 are generally sufficient for studies involving three to five maximum tolerable thresholds, assuming an event rate of 10.0%. Larger sample sizes may be necessary when a greater number of thresholds are involved or when the acceptable event rate is low. Conclusions: The framework of sample size determination facilitates the early identification of potential issues and supports informed decision-making prior to conducting a full-scale study. In general, a sample size of 25 to 30 units is considered adequate for a pilot study, consistent with existing literature. However, larger sample sizes may be necessary when a greater number of thresholds are involved or when the acceptable event rate is low.
Many authors view manuscript rejection as editorial bias, especially when it is before peer review. Often, the real reason is simple: basic journal instructions are not followed. Common problems include missing ethical declarations, absent checklists, improper formatting, and failure to follow journal-specific guidelines. These requirements are not arbitrary. They are based on frameworks such as ICMJE, CONSORT, PRISMA, and STROBE, which promote transparency, reproducibility, and efficiency. When authors do not comply, peer review slows, research is wasted, and scientific communication weakens. Good publishing starts before peer review, with close attention to journal instructions.
Entitlement in biomedical publishing manifests through attempts to bypass peer review, requests for expedited handling, and non-compliance with submission requirements. These practices increase editorial burden, threaten fairness, and may compromise scientific standards. Accelerated editorial workflows may be associated with higher correction and retraction rates. Entitlement reflects structural weaknesses in biomedical publishing systems rather than merely isolated instances of individual misconduct. To address this, journals need clear standards, transparent fast-track rules, mandatory reporting checklists, regular audits, and incentives that reward rigor over speed.
The embedding of lived experience experts (LEEs) is increasingly recognized as important in research, but evidence from low- and middle-income countries (LMIC) remains sparse. This viewpoint aims to present and critically reflect on a model for integrating LEEs into the design of an artificial intelligence (AI)-based mental health (MH) study to develop an automated depression screening system in India. We report on the process of forming a diverse Lived Experience Advisory Panel (LEAP) and show how LEAP influenced methodology, system design, ethics, and language through a three-day workshop and co-design sessions. We also highlight the ethical, structural, and power-dynamic challenges encountered, demonstrating that meaningful LEE partnership is both feasible and essential for developing culturally grounded, safe, and clinically acceptable AI applications in LMIC settings.
