Shashi K. Bhatia

Electroconvulsive therapy during the third trimester of pregnancy.

ECT was administered in two patients during the third trimester of pregnancy. Patient A experienced uterine contractions following the second, third, and sixth treatments. Tocolytic therapy was needed only after the third treatment. Also, following the third treatment, we observed decreased fetal heart rate variability and uterine contraction-related late cardiac deceleration, which indicated fetal compromise. Following the sixth treatment, there was an insignificant drop in biophysical profile score. No such effects were noted with Patient B despite risk factors for premature labor.

Attitudes Toward and Beliefs About Smoking in Grade School Children

A questionnaire was developed to study attitudes toward and beliefs about the health consequences and social value of smoking. After initial evaluation of the instruments reliability, it was administered to approximately 400 children, ranging in age from 7 to 15 years. Significant age effects for some items were demonstrated, but no significant sex effects or sex by age interactions were revealed. Children as young as 7 years were found to be well aware of the health hazards of smoking and likely to express negative attitudes concerning it. We conclude that if smoking prevention programs are to have more than minimal success with youth, they must offer something more than mere information about the health hazards of smoking.

Insomnia during pregnancy: Diagnosis and rational interventions

Sleep disturbances are common in pregnancy. Insomnia is a frequent sleep disturbance experienced by pregnant women which can be primary or due to co-morbid conditions. The differential diagnosis of insomnia in pregnancy includes anxiety disorders, mood disorders, breathing related sleep disorders and restless legs syndrome. Early interventions to treat the sleep disturbance are recommended to avoid adverse pregnancy outcomes. Management strategies include improving sleep hygiene, behavioral therapies, and pharmacotherapy. The risks of pharmacotherapy must be weighed against their benefits due to the possible risk of teratogenicity associated with some medications. Methods: We searched PubMed and Google Scholar employing a combination of key words: pregnancy, sleep disturbances, Obstructive Sleep Apnea, Sleep disorders and insomnia. We included original studies, review articles, meta-analysis and systematic reviews in our search prioritizing articles from the last 10-15 years. Articles older than 15 years were only included if their findings had not been superseded by more recent data. Further selection of articles was done from bibliographies and references of selected articles. Conclusion: Sleep disturbances in pregnancy are common and cause considerable morbidity. Management includes a combination of non-pharmacological and pharmacological treatments carefully weighing the risks and benefits of each for the expectant mother and fetus.

The Bhagavad Gita and Contemporary Psychotherapies

The Bhagavad Gita is based on a discourse between Lord Krishna and Arjuna at the inception of the Kurukshetra war and elucidates many psychotherapeutic principles. In this article, we discuss some of the parallels between the Gita and contemporary psychotherapies. We initially discuss similarities between psychodynamic theories of drives and psychic structures, and the concept of three gunas. Arjuna under duress exhibits elements of distorted thinking. Lord Krishna helps remedy this through a process akin to Cognitive Behavioral Therapy (CBT). We ascertain the analogies between the principles of Gita and CBT, grief emancipation, role transition, self-esteem, and motivation enhancement, as well as interpersonal and supportive psychotherapies. We advocate the pragmatic application of age old wisdom of the Gita to enhance the efficacy of psychotherapeutic interventions for patients from Indian subcontinent and to add value to the art of western psychotherapies.