Deepak Goel

A study on the prevalence of internet addiction and its association with psychopathology in Indian adolescents.

Background: There has been an explosive growth of internet use not only in India but also worldwide in the last decade. There is a growing concern about whether this is excessive and, if so, whether it amounts to an addiction. Aim: To study the prevalence of internet addiction and associated existing psychopathology in adolescent age group. Materials and Methods: A cross-sectional study sample comprising of 987 students of various faculties across the city of Mumbai was conducted after obtaining Institutional Ethics Committee approval and permission from the concerned colleges. Students were assessed with a specially constructed semi-structured proforma and The Internet Addiction Test (IAT; Young, 1998) which was self-administered by the students after giving them brief instructions. Dukes Health Profile was used to study physical and psychosocial quality of life of students. Subjects were classified into moderate users, possible addicts, and addicts for comparison. Results: Of the 987 adolescents who took part in the study, 681 (68.9%) were female and 306 (31.1%) were males. The mean age of adolescents was 16.82 years. Of the total, about 74.5% were moderate (average) users. Using Youngs original criteria, 0.7% were found to be addicts. Those with excessive use internet had high scores on anxiety, depression, and anxiety depression. Conclusions: In the emerging era of internet use, we must learn to differentiate excessive internet use from addiction and be vigilant about psychopathology.

Prevalence of restless leg syndrome in subjects with depressive disorder.

Background: Restless legs syndrome (RLS) is known to be associated with depression. We hypothesized that RLS in depression is linked to the severity, duration, and frequency of depressive episodes. Materials and Methods: Subjects fulfilling DSM-IV-TR criteria of depressive disorders were included in this study after seeking informed consent. Using structured interview of MINI-Plus their demographic data and history were recorded. Severity of depression was assessed with the help of HAM-D. Insomnia was diagnosed following ICSD-2 criteria. RLS was diagnosed according to IRLSSG criteria. Descriptive statistics, Chi-square test, independent sample t test and MANOVA were computed with the help of SPSS v 17.0. Results: RLS was reported by 31.48% of sample. There was no gender difference in prevalence of RLS (X2 =0.46; P=0.33). There was no difference in the age , total duration of depressive illness and number of depressive episodes between RLS and non-RLS groups (F=0.44; P=0.77; Wilks Lambda=0.96). The HAM-D score was higher in the non-RLS group (P=0.03). Onset of RLS symptoms was not related to onset of depressive symptoms. Conclusion: RLS is prevalent in depressive disorder. However, onset of RLS is unrelated to age and number or duration of depressive disorders.

Hindi translation and validation of Cambridge-Hopkins Diagnostic Questionnaire for RLS (CHRLSq).

Background: Restless legs syndrome also known as Willis-Ekbom′s Disease (RLS/WED) is a common illness. Cambridge-Hopkins diagnostic questionnaire for RLS (CHRLSq) is a good diagnostic tool and can be used in the epidemiological studies. However, its Hindi version is not available. Thus, this study was conducted to translate and validate it in the Hindi speaking population. Materials and Methods: After obtaining the permission from the author of the CHRLSq, it was translated into Hindi language by two independent translators. After a series of forward and back translations, the finalized Hindi version was administered to two groups by one of the authors, who were blinded to the clinical diagnosis. First group consisted of RLS/WED patients, where diagnosis was made upon face to face interview and the other group - the control group included subjects with somatic symptoms disorders or exertional myalgia or chronic insomnia. Each group had 30 subjects. Diagnosis made on CHRLSq was compared with the clinical diagnosis. Statistical Analysis: Analysis was done using Statistical Package for Social Sciences (SPSS) v 21.0. Descriptive statistics was calculated. Proportions were compared using chi-square test; whereas, categorical variables were compared using independent sample t-test. Sensitivity, specificity, and positive predictive value of the translated version of questionnaire were calculated. Results: Average age was comparable between the cases and control group (RLS/WED = 39.1 ± 10.1 years vs 36.2 ± 11.4 years in controls; P = 0.29). Women outnumbered men in the RLS/WED group (87% in RLS/WED group vs 57% among controls; χ2 = 6.64; P = 0.01). Both the sensitivity and specificity of the translated version was 83.3%. It had the positive predictive value of 86.6%. Conclusion: Hindi version of CHRLSq has positive predictive value of 87% and it can be used to diagnose RLS in Hindi speaking population.

Sleep-patterns, co-sleeping and parent's perception of sleep among school children: Comparison of domicile and gender

This study was aimed at assessment of sleep schedule, pre-sleep behavior, co-sleeping and parent’s perception of sleep of school going children. Method Four schools each, from urban and rural area were included. Sleep patterns were assessed using the validated Hindi version of Childhood-Sleep-Habit-Questionnaire. Comparison was made between urban and rural group and between boys and girls. Interaction of gender, domicile and school-type was examined on the sleep patterns. Results This study included 831 school children with mean age of 8.9 years. Nearly half of the subjects were boys in this study. Urban children outnumbered those from rural area. Total sleep time on weekdays was 8.3 h that increased to 9.5 h on weekends. Rural children spent more time in sleep than urban children on weekdays and weekends. A higher proportion of urban children felt sleepy during the day. Television watching before bedtime was more common in urban settings. Room sharing was more common among rural children. Nearly 65% rural parents as compared to 77.5% urban parents reported that their child was sleeping sufficient enough. Gender did not affect sleep-schedule and parent’s perception regarding their child’s sleep. Interaction between gender, domicile and school-type did not have any significant effect on sleep patterns. Conclusion Television watching before bedtime was more common among urban school children and they had shorter total sleep time. They had signs of sleep deprivation. Room sharing was more common among rural children. Despite longer sleep time, parents of rural children felt the need for more sleep.

Head banging persisting during adolescence: A case with polysomnographic findings

Head banging is a sleep-related rhythmic movement disorder of unknown etiology. It is common during infancy; however, available literature suggests that prevalence decreases dramatically after childhood. We report the case of a 16-year-old male who presented with head banging. The symptoms were interfering with his functioning and he had been injured because of the same in the past. We are presenting the video-polysomnographic data of the case. Possible differential diagnoses, etiology, and treatment modalities are discussed. The boy was prescribed clonazepam and followed up for 3 months. Parents did not report any episode afterward.

What patients do to counteract the symptoms of Willis-Ekbom disease (RLS/WED): Effect of gender and severity of illness

Objectives: This study was carried out to assess different counteracting strategies used by patients with idiopathic Willis-Ekbom disease (RLS/WED). Whether these strategies were influenced by gender or disease severity was also assessed. Materials and Methods: A total of 173 patients of idiopathic RLS/WED were included in this study. Their demographic data was recorded. Details regarding the RLS/WED and strategies that they used to counteract the symptoms were asked. The severity of RLS/WED was measured with the help of the Hindi version of international restless legs syndrome severity rating scale. They were asked to provide the details regarding the relief obtained from all the strategies they used on three-point scale: no relief, some relief, and complete relief. Results: Of the patients, 72% were females. Mean age of the subjects in this study was 39.6 ± 12.6 years, and male subjects were older than females. Four common strategies were reported by the patients to counter the sensations of RLS/WED: moving legs while in bed (85.5%), asking somebody to massage their legs or massaging legs themselves (76.9%), walking (53.2%), and tying a cloth/rope tightly on the legs (39.3%). Of all the patients who moved their legs, 6.7% did not experience any relief, 64.2% reported some relief, and 28.4% reported complete relief. Similarly, of all the patients who used “walking” to counteract symptoms, 50% reported complete relief, 44.5% reported some relief, and the rest did not experience any relief. Many of these patients reported that massage and tying a cloth/rope on legs brought greater relief than any of these strategies. Tying cloth on the leg was more common among females as compared to males (45.9% females vs. 23.5% males; χ2 = 7.54; P = 0.006), while patients with moderately severe to severe RLS/WED reported “moving legs in bed” (79.3% in mild to moderate RLS/WED; 91.8% in severe to very severe RLS; χ2 = 5.36; P = 0.02). Conclusion: Patients with RLS/WED use a variety of strategies to counteract symptoms. These strategies may be influenced by gender, disease severity, and cultural practices.

Posttraumatic stress disorder symptoms in the population of Uttarkashi, Tehri, and Pauri Garhwal India in reference to Uttarakhand flood - June 2013

Introduction: Natural disasters have the potential to affect psychological health. In June 2013, a multi-day cloudburst caused devastating floods and landslides in the North Indian state of Uttarakhand. Objective: This study aimed to assess the prevalence of posttraumatic stress disorder (PTSD) symptoms in the population of Uttarkashi, Tehri, and Pauri Garhwal 1-year after the cloudburst and flash flood - June 2013. Materials and Methods: PTSD checklist, civilian version (PCL-C) and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV TR) were used as a screening tool. This cross-sectional study after 1-year of the disaster conducted in three districts of Uttarakhand between July and October 2014. Frequencies, percentage, and Chi-square methods were used to calculate the results. Results: Each case adopted for the study was similar on its basic profile. Participants included in the study fell in the symptoms severity range of 5–2 scores of PCL-C. On a match with both criteria - DSM-IV TR criterion and cut-off point of PCL-C Scoring prevalence of PTSD symptoms was found 70.93% in Tehri, Uttarkashi, and Pauri ( n = 1651 with average age of 41 years). A higher prevalence has been noted in female population (Tehri 55.85%, Uttarkashi 55.66%, and Pauri 63.68%) in comparison to male population (Tehri 44.15%, Uttarkashi 44.34%, and Pauri 36.32%). Conclusion: (1) PTSD in disaster victims is as prevalent and persistent in Tehri, Uttarkashi, and Pauri districts of Uttrakhand state in India as elsewhere, (2) the risk of developing PTSD in subjects with lower initial exposure to disaster trauma should not be ignored, (3) remarkably fewer diagnoses of PTSD were made by using both DSM-IV -TR criteria and PCL-C, and (4) Female stress response for natural disaster trauma is comparatively higher than males.

Comparison of Subjective Sleep Quality of Long-Term Residents at Low and High Altitudes: SARAHA Study

STUDY OBJECTIVES To study the effect of altitude on subjective sleep quality in populations living at high and low altitudes after excluding cases of restless legs syndrome (RLS). METHODS This population-based study was conducted at three different altitudes (400 m, 1,900-2,000 m, and 3,200 m above sea level). All consenting subjects available from random stratified sampling in the Himalayan and sub-Himalayan regions of India were included in the study (ages 18 to 84 years). Sleep quality and RLS status were assessed using validated translations of Pittsburgh Sleep Quality Index (PSQI) and Cambridge Hopkins RLS diagnostic questionnaire. Recent medical records were screened to gather data for medical morbidities. RESULTS In the total sample of 1,689 participants included, 55.2% were women and average age of included subjects was 35.2 (± 10.9) years. In this sample, overall 18.4% reported poor quality of sleep (PSQI ≥ 5). Poor quality of sleep was reported more commonly at high altitude compared to low altitude (odds ratio [OR] = 2.65; 95% CI = 1.9-3.7; P < .001). It was more frequently reported among patients with RLS (29.7% versus 17.1% without RLS; P < .001). Other factors that were associated with poor quality of sleep were male sex, smoking, chronic obstructive pulmonary disease (COPD), and varicose veins. Binary logistic regression indicated that COPD (OR = 1.97; 95% CI = 1.36-2.86; P < .001), high altitude (OR = 2.22; 95% CI = 1.55-3.18; P < .001), and RLS (OR = 1.66; 95% CI = 1.12-2.46; P = .01) increased the odds for poor quality of sleep. CONCLUSIONS This study showed that poor quality of sleep was approximately twice as prevalent at high altitudes compared to low altitudes even after removing the potential confounders such as RLS and COPD.

Headache secondary to sleep-related bruxism: A case with polysomnographic findings.

Sleep-related bruxism may present with headache. However, in clinical practice it may be difficult to differentiate from other causes of headache, especially in subjects with substance abuse. We are presenting a case of sleep-related bruxism that presented with headache and sleep-related symptoms in the presence of substance abuse. Polysomnography was used to ascertain cause of headache. How the other possible causes of headache ruled out is also discussed in report. In short, Sleep-related bruxism can cause headache that is worse in the morning. It is associated with poor quality sleep.

Identification of mortality-related predictive factors in hospitalized patients with ischemic stroke

Objective: This prospective study was planned to study the prognostic value of time to presentation to the hospital, clinical scales and examination, hematological and biochemical parameters as predictive factors of mortality in ischemic stroke. Materials and Methods: In this study, 188 consecutive patients of ischemic stroke were included. The patients were subjected to relevant history taking, clinical evaluation, blood investigations (total leukocyte count [TLC], capillary blood sugar, potassium, high-sensitivity C-reactive protein (hs-CRP), troponin I (Trop I)), electrocardiogram (ECG) and neuroimaging. The patients were followed up till their final outcome in the hospital, and patients who expired were grouped as ′Mortality Group′ and the rest as ′Discharged Group′. Logistic regression analysis was carried out among the significant parameters to identify independent predictors of mortality in cases of ischemic stroke. Results: After statistical analysis, it was found that late presentation to the hospital, pyrexia (temperature >99°F), low diastolic blood pressure at the time of admission, hypoxia (saturation of oxygen [sPo2] <94%), National Institute of Health Science scale (NIHSS) score >15, modified Rankin score (MRS) greater than 3, Glasgow coma scale (GCS) less than 8, hyperglycemia (random blood sugar >200 mg/dL), raised total leukocyte count and hs-CRP (>10 mg/L), are positive predictive factors of mortality in cases of ischemic stroke. Conclusion: Late presentation to the hospital, pyrexia (temperature >99°F), low diastolic blood pressure at the time of admission, hypoxia (sPo2 <94%), more severe stroke (NIHSS score >15, MRS >3, GCS <8), high TLC estimated at the time of hospitalization, are the most important predictive prognostic factors of in-hospital mortality in cases of ischemic stroke.