Pronob Kumar Dalal

Randomized controlled trial of standardized Bacopa monniera extract in age-associated memory impairment

Background: Brahmi (Bacopa monniera) is a traditional Indian medicinal plant which causes multiple effects on the central nervous system. The standardized extract of this plant has shown enhanced behavioural learning in preclinical studies and enhanced information processing in healthy volunteers. Aim: To study the efficacy of standardized Bacopa monniera extract (SBME) in subjects with age-associated memory impairment (AAMI) without any evidence of dementia or psychiatric disorder. Methods: A double-blind, placebo-controlled randomized study design was employed. The subjects received either 125 mg of SBME or placebo twice a day for a period of 12 weeks followed by a placebo period of another 4 weeks (total duration of the trial 16 weeks). Each subject was evaluated for cognition on a battery of tests comprising mental control, logical memory, digit forward, digit backward, visual reproduction and paired associate learning. Results: SBME produced significant improvement on mental control, logical memory and paired associated learning during the 12-week drug therapy. Conclusion: SBME is efficacious in subjects with age-associated memory impairment.

Psychiatric aspects of burn

Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychological outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.

Vajikarana: Treatment of sexual dysfunctions based on Indian concepts

Vajikarana or Vrishya chikitsa is a one of eight major specialty of the Ashtanga Ayurveda. This subject is concerned with aphrodisiacs, virility and improving health of progeny. As per Charak Samhita, by proper use of these formulations, one becomes endowed with good physique, potency, strength, and complexion and sexually exhilarated and sexually potent. This in turn is helpful in many common sexual dysfunctions, including Infertility, Premature Ejaculation and Erectile dysfunction. The therapy is preceded by living in strict compliance with the directions mentioned in Ayurvedic classics, various methods of body cleansing and other non-medicinal strategies like sexual health promoting conduct, behavior and diet. Certain individualized herbal and herbo-mineral combinations are administered as per the nature of a person according to the Ayurveda. Many limitations need to be considered before considering the use of theses therapy like lack of scientific studies, possibilities of adulteration in the herbal and herbo-mineral combinations available in market and possibilities of unexpected side-effects etc., The article calls upon initiating research in this area so that claims of ancient Ayurvedic texts could be substantiated and vajikaran therapy may be utilized by modern medicine.

Metabolic syndrome and central obesity in depression: A cross-sectional study

Introduction: The current epidemiological data and meta-analyses indicate a bidirectional association between depression and metabolic syndrome (MetS). Aims: To assess the prevalence of metabolic syndrome and obesity in drug naïve patients (in current episode) having Recurrent Major Depressive Disorder and Bipolar Depression. Method: This was a single point cross sectional observational study that involved administration of diagnostic and assessment tools and blood investigations. Recruitment for the study was done from a period of September 2008 to august 2009. Results: The prevalence of MetS was significantly more in the depression group when compared to healthy controls. The Bipolar depression group had 24% prevalence and recurrent depression group had 26% prevalence as opposed to none in the control group. The prevalence of MetS did not differ significantly amongst the both depression groups. Presence of central obesity was significantly more in the recurrent depression (30%) and Bipolar depression (24%) as compared to controls (8%). There was no statistically significant difference between the two depression subgroups. Discussion: Our study adds to the mounting evidence that links the presence of depression and metabolic syndrome. As we had ensured a drug free period of at least 3 months, the findings in our study indicate that the metabolic syndrome observed in our study is independent of drug exposure. Conclusions: This study demonstrated significantly more incidence of metabolic syndrome and central obesity in patients of depression than age and sex matched controls.

Assessment of cognition in non-affected full biological siblings of patients with schizophrenia.

Background: Schizophrenia is a devastating psychotic illness which is like the most mental disorders, shows complex inheritance; the transmission of the disorder most likely involves several genes and environmental factors. It is difficult to judge whether a particular person without schizophrenia has predisposing factors for the said disease. A few studies have shown the relative sensitivity and reliability of cognitive and psychophysiological markers of brain function as the susceptibility factors for schizophrenia which may aid us to find people with an increased risk of complex disorders like schizophrenia. The present work is an exploration on cognitive impairments in unaffected siblings of patients suffering from schizophrenia with a framework to explore why a mental disorder occurs in some families but not in others. Materials and Methods: This is a single point non-invasive study of non-affected full biological siblings of patients with schizophrenia, involving administration of a battery of neuropsychological tests to assess the cognitive function in the sibling group and a control group of volunteers with no history of psychiatric illness. The control group was matched for age, gender, and education. The siblings were also divided on the basis of the type of schizophrenia their siblings (index probands) were suffering from and their results compared with each other. Results: The siblings performed significantly poorly as compared to the controls on Wisconsin card sorting test (WCST), continuous performance test (CPT), and spatial working memory test (SWMT). The comparison between the sibling subgroups based on the type of schizophrenia in the index probands did not reveal any significant difference. Conclusion: These findings suggest that there is a global impairment in the cognition of the non-affected siblings of patients of schizophrenia. Cognitive impairment might be one of the factors which will help us to hit upon people who are predisposed to develop schizophrenia in the future.

National Mental Health Survey of India, 2016 - Rationale, design and methods

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014–15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015–16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015–16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Psychosocial factors associated with relapse in patients with alcohol dependence

Introduction: Despite the recent developments in the biology of addiction, a significant part of relapse and its management is still influenced by psychosocial factors and the interplay between them. This study aims at finding the extent of association of various psychosocial factors with relapse in patients of alcohol dependence. Materials and Methods: It is a cross-sectional study of two groups of alcohol dependence patients: abstinence (n = 31) and relapse (n = 35). Demographic, clinical, and psychosocial variables were compared between the two groups. Statistical analyses were aimed at finding the extent of association between various factors and relapse. Results: Demographic variables such as family history of substance dependence (odds ratio [OR] =2.09; confidence interval [CI] =0.74–5.90) and past history of ≥2 relapses (OR = 2.71; CI = 0.83–8.87) were associated with relapse in alcohol dependence. Clinical variables such as younger age of onset of dependence (Mean difference = −3.93; 95% CI = −7.66 - −0.21; P = 0.038) and shorter time to develop dependence (Mean difference = −3.08; 95% CI = −5.53 -−0.63; P = 0.014) were significantly associated with relapse. Of the psychosocial variables, coping behavior (OR = 6.54; CI = 1.17–36.74) had the highest association with relapse followed by relapse precipitants (OR = 1.42; CI = 1.16–1.74). Conclusion: Coping behaviors to adverse situations have greater association with relapse among psychosocial variables than the number of high-risk situations a patient experiences. Interventions targeted at improving coping skills can help patients stay abstinent.

Stress among medical students: A cross-sectional study from a North Indian Medical University

Aims: The aim is to study stress among medical students and the relationship of stress to the year of study and gender. Materials and Methods: A single-point, cross-sectional, observational study of students of a medical university in North India divided on the basis of the semester of their course. The study was done using the higher education stress inventory. Results: A total of 251 students were included in the study. Worry about future endurance and capacity was rated the highest by the final year students while faculty shortcomings and insufficient feedback were rated highest by the 2nd-year students and financial concerns the highest by the 1st-year students. Males rated financial concerns higher than females. Discussion: The study would provide insight to the university authorities to make remedies based on the expectations and feedback of the students. Conclusion: the current study shows that stress amongst medical students is a dynamic process as the reasons of stress vary depending on the stage of curriculum. The college/ university administration can mitigate this by taking appropriate steps as needed

A cross-sectional study of cognitive functions and disability in schizophrenia from a tertiary care hospital in North India

Background: Cognitive functions are important predictors of day to day functioning. Cognitive functions are significantly affected in schizophrenia and various other psychiatric disorders. There are very few Indian studies studying the relationship between cognitive functions and disability. Aims and Objectives: The purpose of the present study was to assess the cognitive functions in stable patients of schizophrenia and compare them with normal controls and also to study the relationship between cognition and disability in these patients. Materials and Methods: Thirty stable patients of schizophrenia attending psychiatry outpatient clinic of a Tertiary Care Hospital of North India were included in the study. Thirty healthy volunteers with no psychiatric illness matched for age, gender, and education were also included cognitive functions were assessed using Brief Assessment of Cognition in Schizophrenia and disability was assessed using WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Results: Highly significant difference (P < 0.0001) was found between the cognitive functions of the schizophrenia group and healthy control group. The patients of schizophrenia had a maximum disability in the area of life activities followed by participation and cognition. There existed a significant negative correlation between cognition and mobility (r = −0.45, P < 0.05), getting along with people (r = −0.44, P < 0.05), life activities (r = −0.42, P < 0.05), participation (r = −0.39, P ≤ 0.05), and total scores on WHODAS 2.0 (r = −0.48, P ≤ 0.05). Conclusion: Cognitive functions are an important predictor of disability. Cognitive deficits exist even in the stable patients of schizophrenia which is significantly higher than the healthy group.

Impact of alcohol on the developing brain

Development of the brain is a continuous process, starting in the intrauterine life and continuing till death. The consumable form of alcohol — Ethanol — has a significant impact on the developing brain. Ethanol has its impact on the brain through genetics, protein synthesis, expression of different receptors, inflammatory and toxic changes, as well as, dysregulation of neurotransmitters. The impact of alcohol on the developing brain is a potential area of research. This article gives an insight into the recent updates on the animal as well as human research on the impact of alcohol on the developing brain.