Pregabalin (a Gabapentinoid) has been shown to have potential for non-medical use. We aimed at exploring the prevalence and clinical correlates of non-medical use of pregabalin and dependence in patients seeking treatment for substance use disorders (SUDs). Patients with ICD-10 diagnosis for various SUDs, in the age range of 18–70 years who consented for participation in this study were evaluated for non-medical use and dependence of pregabalin across three different regions of Punjab and the union territory of Chandigarh. ICD-10 criteria for a dependence syndrome (three or more criteria) were used for defining dependence on pregabalin. Out of a total 974 patients enrolled in this study, 44.6

Hikikomori, a form of pathological social withdrawal, has gained international recognition beyond its initial description in Japan. The COVID-19 pandemic has heightened awareness of social withdrawal behaviors globally, yet data from India remains limited. We present three cases of adolescents aged 16 years who met the updated diagnostic criteria for hikikomori: marked social isolation at home for >= 6 months with significant functional impairment. All three cases presented with concurrent psychiatric comorbidities, including major depressive disorder, obsessive-compulsive disorder, and social anxiety disorder. Duration of social withdrawal ranged from 8 to 24 months. Functional impairment was evident across educational, social, and occupational domains. Treatment response was partial despite multimodal interventions including pharmacotherapy and cognitive-behavioral therapy. These cases met updated hikikomori criteria and fit secondary hikikomori, with persistent withdrawal despite symptom relief, implying need for targeted exposure-based, family-informed, and engagement-focused care. COVID-19 context likely precipitated but did not fully explain persistence, supporting a pathological pattern in a high-expectation family milieu. These cases demonstrate the clinical presentation of hikikomori in the Indian context, highlighting the need for early recognition and specialized interventions for pathological social withdrawal in adolescents.

Background:Studies suggest that obesity is linked to both autonomic nervous system dysfunction and cognitive impairment, but the specific quantitative associations are not well explored. Purpose:This study was proposed to explore the quantification of different neurocognitive signatures and heart rate variability (HRV) parameters with increasing body weight among metabolically healthy obese participants for better analytical predictors. Methods:The present research is a cross-sectional study, including a total of 101 (n = 101) participants. Out of the total, 71 were metabolically healthy obese or overweight individuals (body mass index [BMI] = 23.0-30.0 kg/m2; age 36-55 years; both genders) and 30 participants were enrolled as the control group. All the participants completed various neurological and psychological assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), serum levels of brain-derived neurotrophic factor (BDNF) and cardio-autonomic tone by HRV analysis. Results:Significant changes were observed for neurocognitive performances and HRV indices for the metabolically healthy obese group compared with the control group. With the association heatmaps, BMI was found to be significantly negatively associated with the BDNF and high-frequency band (HF band, ms2). In socio-demographic-adjusted models, the analysis showed a substantial decline (p < .05) in the HF band, ms2 with an increase in BMI, emphasising its significant effect on vagal tone among the obese group. Also, a noteworthy association between BDNF levels and the standard deviation of all normal-to-normal intervals (SDNN)-HRV indices have confirmed the robustness of the findings for obese participants when compared with the control group. Conclusion:The findings of the present study support that HRV could be a valuable early non-invasive tool for future cognitive decline in a population with metabolically healthy obesity. Clinical Trial Registry:The study was registered at Clinical Trial Registry of India (CTRI/2022/10/046935).

BACKGROUND:The present study utilized multidimensional item response theory (IRT) analyses to shorten the 61-item suicide crisis inventory (SCI-2) to an abbreviated version suitable for high-volume settings METHODS: Participants were adults with major depressive disorder (MDD) and healthy controls recruited from 24 tertiary care hospitals. The MDD sample was randomly split into training (Sample 1: 75 %) and validation (Sample 2: 25 %) datasets to perform IRT analyses, confirm the factor structure of the resultant scale, and assess convergent, discriminant, and incremental validity of the shortened scale(s). RESULTS:We recruited 1196 patients (54.8 % female, Mage=38.1 years) and 1067 control participants (50.5 % female, Mage=36.7 years). The SCI-2 was shortened to an abbreviated 7-item version (A-SCI-2) with strong model fit in all three samples (Sample 1: n = 897, χ2[14] = 54.76, p < .001, CFI =.999, TLI =.998, RMSEA =.057, SRMR =.028; Sample 2: n = 299, χ2[14] = 21.73, p = .084, CFI =.999, TLI =.999, RMSEA =.043, SRMR =.030; and Controls: χ2[14] = 63.11, p < .001, CFI =.997, TLI =.996, RMSEA =.057, SRMR =.040) and retaining the original five-factor structure. Good to high internal consistency was noted in all 3 samples. Strong correlations were noted between the A-SCI-2 and the corresponding full scale, while convergent/discriminant validity correlations were comparable between shortened and full scales. The A-SCI-2 demonstrated modest incremental predictive validity. CONCLUSION:The A-SCI-2 is a brief, valid, self-report tool to assess the SCS, and may be useful in busy practice settings.

Depressive disorders are highly prevalent worldwide and contribute a major chunk to the disease burden. It is estimated to become the leading cause of disability-adjusted life years by the end of this decade. Women are at two times increased risk of suffering from depression in comparison to men. This narrative review focuses on various psychosocial factors which have been shown to be the determinants of depressive disorders among women. Although the etiology of specific forms of depression, i.e. premenstrual dysphoric disorders, depression during pregnancy, and postpartum and perimenopausal period is not known, these contribute to an increased prevalence of depression among women. There is contradicting evidence for the role of sociodemographic factors and depression among women with similar rates in high-, low-, and middle-income group countries. Unstable marital relationship, low educational status, and unplanned pregnancies are associated with depression. High interpersonal sensitivity, internalizing personality traits, low self-esteem, and poor coping styles predispose women to depressive disorders. The burden of undertaking multiple roles, poor social support, stressful life events, intimate partner violence, physical pregnancy-related complications, and gender biases are often associated with an increased risk of depression among women. Hence, an emphasis must be laid on the early detection of depressive symptoms, evaluation of psychosocial factors, and managing symptoms linked to the reproductive cycle of women. Comprehensive management of depression among women shall comprise public awareness and education, screening for depressive symptoms, addressing psychological and social factors, tailoring pharmacotherapy, and provision of cost-effective culturally appropriate psychological interventions.

BACKGROUND:The prevalence of depression among adolescents with asthma is reported to be 27%-34% across different geographical regions. Asthma control depends on inhaler adherence. Studies on the association of depression and inhaler adherence among adolescents with asthma are few, especially in the Indian subcontinent. Therefore, this study was carried out to find the prevalence of depression and its association with inhaler adherence among adolescents with asthma. METHODS:A hospital-based analytical cross-sectional study was carried out among 102 adolescents with asthma in a tertiary care setting. Symptoms of depression were assessed using the Center for Epidemiological Studies-Depression Scale for Children (CES-DC) and inhaler adherence using Test of Adherence to Inhalers (TAI). RESULT:Among the 102 adolescents with asthma, depression was detected in 39 (38.2%). As per the TAI scores, good, intermediate, and poor adherence to inhalers were, respectively, found among 35 (34.3%), 41 (40.2%), and 26 (25.5%) of the adolescents with asthma. On multivariable binary logistic regression analysis, the adolescents with intermediate and poor adherence to inhalers, respectively, had 7.093 odds (95% CI 2.189-22.977) and 9.002 odds (95% CI: 2.501-32.405) of having depression compared to those with good adherence. Those adolescents with families whose monthly income was INR 12,000 or less had 2.490 odds (95% CI: 1.002-6.187) of depression compared to those with more than INR 12,000 monthly family income. CONCLUSION:The level of inhaler adherence in a dose-dependent manner and lower family income were independent predictors of depression among adolescents with asthma. The findings indicate the need to screen and assess adherence and symptoms of depression among them and manage appropriately, focusing on those with low family income.

OBJECTIVE:The suicide crisis syndrome (SCS) is a suicide-specific acute cognitive-affective state that seeks to identify individuals at increased near-term risk of suicide. However, little is known about its correlates in psychiatric populations. We aimed to assess symptom severity and sociodemographic correlates of SCS in patients with major depressive disorder (MDD), compared to healthy controls. METHODS:Between November 2021 and August 2022, we cross-sectionally administered the revised Suicide Crisis Inventory (SCI-2) to patients with MDD and matched healthy controls across 24 centers in India. We compared SCS total and domain scores between groups using independent samples t-tests. Linear regressions were used to determine the sociodemographic characteristics uniquely associated with SCS, over and above clinical diagnosis. RESULTS:We obtained responses from 1196 patients with MDD (Mean age = 38.1 ± 12.2 years, 54.8% female) and 1067 controls (Mean age = 36.7 ± 11.4 years, 50.5% female). The MDD group had significantly greater severity of total SCS symptoms (t[2063]= -58.57, p < 0.001, Cohen's d = 2.42) and each of its five domains. In multivariate analyses, age (B= -.37, SE=.11, p < 0.001), female sex (B = 3.61, SE = 1.62, p = 0.026), and living in a nuclear family (B= -3.97, SE = 1.73, p = 0.022) were significantly associated with SCS symptoms. The relationship between age and SCS symptoms was significantly stronger among MDD patients (B= -0.48, SE = 0.14, p < 0.001). CONCLUSION:Our findings are consistent with prior cross-national investigations of SCS correlates in community samples and overlap with correlates of suicidal behavior. These results point to the potential utility of the SCS construct in early identification of at-risk individuals and prevention of subsequent suicidal behavior.

Background Studies suggest that obesity predisposes individuals to developing cognitive dysfunction and an increased risk of dementia, but the nature of the relationship remains largely unexplored for better prognostic predictors. Purpose This study, the first of its kind in Indian participants with obesity, was intended to explore the use of quantification of different neurocognitive indices with increasing body mass index (BMI) among middle-aged participants with obesity. Additionally, machine-learning models were used to analyse the predictive performance of BMI for different cognitive functions. Methods In the cross-sectional analytical study, a total of 137 ( n = 137) participants were included. Out of the total, 107 healthy obese (BMI = 23.0–30.0 kg m−2; age between 36 and 55 years of both genders) were recruited from the out-patient department of the Department of Endocrinology and General Medicine, and 30 participants were recruited as the control group, between March 2023 to February 2024. The participants underwent neuropsychological assessments, including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA) and serum levels of brain-derived neurotrophic factor (BDNF). Results Significant ( p < .05) differences were observed for neurocognitive functions for the obese group versus the control group. According to the correlation heatmaps, BMI was significantly ( p < .05) negatively associated with BDNF. Multivariate linear regression analysis revealed a substantial ( p < .05) decline in BDNF with a change in BMI, accenting its significant impact on cognitive ageing. Additionally, consistent decreasing trends were observed across the MoCA and MMSE, confirming the robustness of the findings across diverse analytical methodologies. Furthermore, the linear regression model and super vector machine model contributed additional evidence to the consistency of the trends in cognitive decline linked to BMI variations. Conclusion The preliminary results of the present study support that increased BMI is an important physiological indicator that influences neurocognition and neuroplasticity in individuals with obesity.

OBJECTIVES:This study aims to explore the relationship between chronotypes, sleep quality, and anxiety among medical undergraduates, providing valuable insights for academic institutions seeking to enhance student well-being. METHODS:A cross-sectional design was used, involving 200 medical undergraduates who were selected based on specific inclusion and exclusion criteria. Data collection included comprehensive clinical histories and the administration of three validated questionnaires: the Morningness-Eveningness Questionnaire Self-Assessment (MEQ-SA), the Pittsburgh Sleep Quality Index (PSQI), and the State-Trait Anxiety Inventory (STAI). Participants were recruited during class breaks, and informed consent was obtained prior to participation. RESULTS:The majority of participants (76.5 %; n=152) exhibited a neutral chronotype, with a mean MEQ score of 50.18 (±7.781). No significant correlations were found between MEQ scores and variables such as sex, BMI, or electronic media use. However, individuals classified as evening types reported higher anxiety levels, with mean STAI-S and STAI-T scores of 56.09 (±4.566) and 49.09 (±6.202), respectively (ANOVA, F=31.798, p=0.001; F=30.294, p=0.001). The mean global PSQI score was 6.00 (±2.553), with 56 % of participants reporting poor sleep quality. Evening chronotypes had significantly poorer sleep quality, as evidenced by higher PSQI scores (8.14±1.670) (ANOVA, F=43.663, p=0.001). CONCLUSIONS:The findings underscore the need for academic institutions to reconsider the alignment of academic schedules with students' chronotypes, potentially enhancing academic performance and reducing health risks. Despite these contributions, the study has limitations, including geographical and demographic constraints and reliance on self-reported data, suggesting the need for further research to provide more comprehensive insights.

Psychotherapy of different types is recognized across the globe as an essential component of child and adolescent mental health services. At the same time, there are barriers and challenges in obtaining access to this modality that are as widespread as its acceptance. This article reviews barriers to accessing child and adolescent psychotherapy in high-income countries (HIC) as well as low/middle-income countries (LMIC). It also briefly reviews approaches to improve access using different interventions and modalities. We also report on our experience using one particular intervention, case management within pediatric collaborative care, as a promising approach for improving access in underserved populations.

Background: Physical activity (PA) offers innumerable benefits and is a promising intervention against common mental disorders, such as depression and anxiety. We examined the association between PA and depression or anxiety in adults. Materials and Methods: A study was conducted between March 2021 and August 2022 using a cross-sectional study design. We recruited 334 participants >40 years of age from the noncommunicable disease (NCD) screening clinic of a tertiary care institute in North India. Health-enhancing PA (HEPA) was estimated using the International Physical Activity Questionnaire (IPAQ), while depression and anxiety were screened using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder scales. Bivariate and univariate analyses were performed using Statistical Package for the Social Sciences (SPSS) version 21 to depict our results. Results: Engagement in HEPA was 23.4%. The HEPA depicted significant socioeconomic disparities. The mean total cholesterol and triglyceride levels were considerably higher in the HEPA active group, despite having lower GAD-7 and PHQ-9 scale scores. The prevalence of depressive and anxiety symptoms was 59.0% and 13.4%. PA depicted better odds against depression but not against anxiety symptoms. Conclusions: Low HEPA engagement in adults is a matter of concern, and it is high time we look beyond NCDs toward the risk factors. It is essential to incorporate PA counseling universally and not be restricted to a particular clinical department to realize its full potential in restraining the growing NCD burden.

Background: The revised Suicide Crisis Inventory (SCI)-2 is a self-report measure to assess the suicide crisis syndrome (SCS). We aimed to assess the factor structure, reliability, and validity of SCI-2 among adults with major depression.Methods: Using a cross-sectional design, between November 2021 and August 2022, the Hindi SCI-2, along with other self-report measures, was administered to Indian adult respondents clinically diagnosed with major depression across 24 centers in India. Confirmatory factor analysis was carried out to test the factor structure of SCI-2. Additionally, convergent, discriminant, and criterion validity were tested using bivariate or biserial correlations, as appropriate.Results: We obtained responses from 654 participants (Mean age = 36.9 +/- 11.9 years, 50.2 % female). The SCI-2 fit both a one-factor (chi(2)[1769] = 14,150.74, p < .001, CFI = 0.98, RMSEA = 0.10), and five-factor solution (chi(2)[1759] = 13,130.83, p < .001,CFI = 0.98, RMSEA = 0.10) with the five-factor solution providing a significantly better fit. Internal consistencies of the SCI-2 total and subscale scores ranged from good to excellent. Most subscales significantly converged with each other and with other relevant measures although these associations were weak for thwarted belongingness and goal reengagement subscales. Small to moderate associations were noted in support of discriminant and criterion validity.Limitations: We could not assess the predictive validity of SCI-2 for suicidal behaviors.Conclusion: Consistent with prior data, the Hindi SCI-2 fit a five-factor solution and showed good psychometric properties. These findings support the use of SCI-2 to assess SCS among Indian adults with major depression.

Introduction:Treatment adherence rates among patients of affective disorders remain sub-par across the world. Sociocultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualize the same. Methodology:The study utilized a qualitative grounded and phenomenological approach study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key caregivers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5, which was used as the interview tool. Thematic analysis of data was performed using Atlas.ti version 8.4.3. Results:A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included cultural and societal attitude toward illness and treatment-seeking, trust, experience, and expectations from available health care, faith healing-related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help-seeking, also showed prudent findings. Conclusion:The study findings demonstrate the various features of the sociocultural milieu and identity of an individual and family that have an influence on treatment-seeking behavior.

Background:Restless legs syndrome (RLS) is a neuro-sensorimotor disorder which is scarcely researched and is commonly missed in routine psychiatry practice. Aim:To evaluate the prevalence of RLS and its correlates in patients with anxiety, depression, and somatoform disorders. Methods:A cross-sectional single-center study was undertaken in patients aged 18-65 years suffering from ICD-10 (International Statistical Classification of Diseases-10th edition) diagnosis of anxiety, depressive, and somatoform disorders. RLS was evaluated by using diagnostic criteria of International Restless Legs Syndrome Study Group (IRLSSG) and severity measured on IRLSSG scale. Depression and anxiety were rated on Hamilton Depression and Anxiety Rating Scales respectively, insomnia severity measured by Insomnia Severity Index (ISI), and quality of life measured by WHO Quality of Life-Brief version (WHO-QOL BREF) scale. Serum ferritin levels were measured for evaluating iron deficiency. Results:The rate of RLS was 66.7%, 50%, and 48% in patients with depressive, anxiety, and somatoform disorders, respectively, with no significant inter-group difference. Nearly one-third of patients suffered from severe to very severe symptoms of RLS, and quality of life was poorest in those with depressive disorders. RLS was significantly higher in females (P = 0.019), who were married (P = 0.040), diagnosed with severe depression (P = 0.029), and abused benzodiazepines (P = 0.045). On binary logistic regression, female gender and presence of clinical insomnia predicted occurrence of RLS. Conclusion:The prevalence of RLS is very high in patients with common psychiatric disorders which is often missed. Clinical enquiry and examination for reversible causes such as iron deficiency may assist in its diagnosis and improve clinical outcome.

Background: The Suicidal Narrative Inventory (SNI) is a 38-item self-report measure developed to assess elements of the suicidal narrative, a subacute, predominantly cognitive, presuicidal construct. Our objectives were to assess the factor structure, validity, and reliability of the SNI-38 among adults with major depressive disorder (MDD). Methods: Using a cross-sectional design, we administered the Hindi version of the SNI along with other self-report measures to adults with MDD, recruited from 24 tertiary care hospitals across India. Confirmatory factor analysis (CFA) was performed to assess the factor structure of SNI-38. Reliability (internal consistency) was assessed using Cronbach's alpha (alpha). Convergent, discriminant, and criterion validity of the SNI-38 were tested by comparing it against other appropriate measures. Results: We collected usable responses from 654 Hindi-speaking participants (Mean age = 36.9 +/- 11.9 years, 50.2% female). The eight-factor solution of the SNI showed good model fit indices (chi 2[637] = 3345.58, p <.001, CFI =.98, and RMSEA =.08). Internal consistencies for the SNI subscale scores were good to excellent, alpha ranging from .73 to.92. While most subscales significantly converged with other measures, associations were comparatively weaker and inconsistent for the 'thwarted belongingness' and 'goal reengagement' subscales. Conclusion: Consistent with prior data, our study confirmed an eight-factor solution and demonstrated adequate psychometric properties for the Hindi version of the SNI-38 in our sample. These findings provide empirical support for the use of SNI to assess the suicidal narrative among Indian adults with MDD.

ima-advises-members-to-avoiddrinking-with-non-docs/articleshow/59316367.cms (2017, accessed February 19, 2022). 17. ET Online. How much alcohol is safe in your pilot’s blood: DGCA says zero. https://economictimes.indiatimes.com/ news/et-explains/explained-why-it-istough-to-find-a-tipsy-pilot-in-india/ articleshow/66605164.cms (2018, accessed February 19, 2022). 18. Grover S, Sahoo S, Bhalla A, and Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: a crosssectional study. Indian J Psychiatry 2018 Apr-Jun; 60(2): 175–188.