Year : 2018 | Volume
: 60 | Issue : 5 | Page : 15--16
Young Psychiatrist Award
|How to cite this article:|
. Young Psychiatrist Award.Indian J Psychiatry 2018;60:15-16
|How to cite this URL:|
. Young Psychiatrist Award. Indian J Psychiatry [serial online] 2018 [cited 2021 Jun 19 ];60:15-16
Available from: https://www.indianjpsychiatry.org/text.asp?2018/60/5/15/224518
Understanding ‘recovery’ in opioid dependence: A qualitative grounded theory study at a de-addiction centre at a tertiary hospital in north India
Aniruddha Basu, SK Mattoo, D Basu, BN Subodh, SK Sharma
Department of Psychiatry, PGIMER, Chandigarh.
Background: All de-addiction treatments aim at abstinence in a narrow sense and ‘recovery’ in a broader sense.
Aim: Understanding ‘recovery’ in opioid dependence(OD).
Objective: To develop a conceptual framework for ‘recovery’ in OD through a qualitative approach.
Methodology: This is a cross-sectional, descriptive and qualitative (grounded theory) study. Consenting males with OD, with illicit or prescription opioids were recruited through ‘purposive’ and ‘theoretical’ sampling. Initially four focus group discussions (FGD) conducted among different stakeholders namely drug users, caregivers and treatment providers were transcribed and open-coding was done for the development of a semi-structured interview guide which helped to conduct in-depth interviews with four ‘recovered’ patients (opioid abstinent for at least one year), three opioid dependent patients (Illicit/pharmaceutical opioids within last one year), three care-givers and three mental health professionals of different background. Upon further axial and selective coding through constant comparative methods and memoing, a ‘theoretical saturation’ was achieved and a conceptual framework emerged.
Results: The conceptual framework consisted of ‘initiating recovery’ with the help of family support and intrinsic and motivational factors thereby navigating through the ‘barriers’ for ‘changes in recovery’ through diverse ‘means of attaining recovery’ leading to the reversible process of ‘recovery in general’ characterised by ‘complete abstinence’ with an ‘inner experience’ amidst a cultural understanding of ‘punarjanam’ or ‘rebirth’.
Discussion and Conclusion: Social Constructivist approach yielded a middle-range grounded theory model of ‘recovery’ in OD in India named as the ‘Chakra Model’ which needs to be established through quantitative verification.
Conflict of Interest: NIL
Ethical Permission: Institute Ethics Committee
Keywords: Opioid dependence, DE addiction
Is Melancholic Depression Different from Non-Melancholic Depression? A 6 Months’ Prospective, Hospital Based Study
Ravindra Munoli, Samir Kumar Praharaj, P S V N Sharma, Rajeshkrishna Bhandary P
Department of Psychiatry, Kasturba Medical College, Manipal, Manipal University, Manipal, Udupi, Karnataka
Background: Binarian model views melancholia as a distinct depressive class. Unitarian model views it as a more severe expression of depression. Pursuit of the status of melancholia has seen efforts by many since ancient times and it is still struggling to find a strong foothold as a disease.
Objective: To study the socio-demographic, clinical and course differences between melancholic and non-melancholic depression categories.
Method: It was a prospective, naturalistic, hospital based study of 50 in-patients diagnosed with unipolar depression in a tertiary centre. Patients were categorized into melancholia (>8) and non-melancholia using CORE questionnaire. Patients were evaluated on Hamilton depression rating Scale (HAM-D), Hamilton anxiety rating scale (HAM-A), Somatoform Symptom Checklist (SSC), CSSRS (Columbia suicide severity rating scale), Clinical Global Impression (CGI), presumptive stressful life-events scale (PSLES) at baseline and at 1st, 3rd and 6th month.
Results: Melancholia group had significantly higher depression scores (p=.00,Cohen’s d=1.51), higher anxiety score (p=.05,Cohen’s d=0.56), CGI scores and psychotic depression (p=.007,phi=0.38). Higher suicidal ideation was seen in melancholic group but suicidal behaviour and actual attempts did not differ. During follow ups, all sub components of melancholia namely, non-interactiveness, retardation and agitation, showed reduction in scores. Age, gender, education, life events, occupation, comorbidities did not show significant effect. By 1st month 25.8%, by 3rd month 8.33%, by 24 weeks 12.5% were melancholic.
Conclusion: Construct and course of melancholia may be viewed as a part of depression, more in lines with severe depression. Melancholia increases the risk for suicidal ideation but not behaviour or attempts.
Comparative efficacy of adjunctive theta burst stimulation to left dorsolateral prefrontal cortex and right inferior parietal lobule on social-cognitive deficits in schizophrenia: A sham-controlled, rater-blind experiment with evoked response gamma power as response biomarker
Sai Krishna Tikka
Aim: To investigate the comparative efficacy of adjunctive continuous theta burst stimulation (cTBS) to left dorsolateral prefrontal cortex (ltDLPFC)and right inferior parietal lobule (rtIPL) on social-cognitive deficits, and gamma power evoked during cognitive tasks, in schizophrenia.
Study design: A sham-controlled, rater-blind experiment
Methods and materials: A group of 76 schizophrenia patients either received active or sham cTBS to either ltDLPFC or rtIPL. Each patient received a total of 10-sessions over a period of 2-weeks (5/week). MRI neuro-navigation was used to locate the target and to deliver pulses. All participants underwent a high-resolution (256 channels) EEG recording while performing ‘facial emotion recognition (FER)’ and ‘Stroop color-word-interference (SCWI)’ tasks. Evoked gamma spectral power was assessed across 10 regions of interests. Psychopathology and social functioning were also assessed.
Results: Significant improvement in recognition indices was seen in active-ltDLPFC and active-rtIPL compared to respective sham groups. Changes in active-ltDLPFC was significantly greater than active-rtIPL group. Significant improvement in the stroop-interference was seen only in the active-ltDLPFC.
Gamma power evoked by FER reduced in right inferior parietal (rtIPL), medial prefrontal (MPF), right inferior frontal regions, in those receiving active cTBS to ltDLPFC and rtIPL. In those receiving active cTBS to ltDLPFC, gamma power evoked by SCWI significantly reduced in left DLPFC. In the active ltDLPFC group, percentage change in emotion recognition indices significantly correlated with changes in stroop interference scores, changes in gamma power in rtIPL during FER and changes in gamma power in ltDLPFC during SCWI; in this group changes in gamma power in rtIPL during FER and in ltDLPFC during SCWI, were positively correlated. No correlations with psychopathology was found.
Conclusion: Although both cTBS to ltDLPFC and rtIPL are effective to improve social cognition, cTBS to ltDLPFC is better. Gamma power evoked by FER in rtIPL and by SCWI task in ltDLPC may be useful biomarkers for response on social cognitive deficits in schizophrenia.
Keywords: Schizophrenia, Social cognition, evoked gamma oscillatory activity, rTMS, Theta burst stimulation, response marker
Reduced heart rate variability in alcohol use disorder: relationship with severity of depressive symptoms in post acute alcohol withdrawal state
Background: Alcohol Use Disorder (AUD) and depression are both associated with autonomic dysfunction (AD). Monitoring those with AUD for indicators of AD such as reduced Heart Rate Variability (HRV) helps in detecting early asymptomatic and preclinical changes in a patient who could be at risk of developing end-organ dysfunction. There is limited research on how presence of depressive symptoms in those with AUD impacts their autonomic functioning.
Objectives: The current study aimed to measure cardiac autonomic function parameters in patients with AUD post management of acute withdrawal and to correlate them with presence and severity of co-morbid depressive symptoms, and clinical features.
Materials and methods: Cross-sectional observational study; in-patients who met selection criteria were recruited through convenience sampling. AUD diagnosis was made as per DSM-5 criteria; severity of AUD & depressive symptoms were measured using Severity of Alcohol Dependence Questionnaire (SADQ) and Hamilton Depression Rating Scale (HDRS) respectively. AD was assessed using time and frequency domain measures of short-term heart rate variability. Hierarchical regression analysis was used to control factors potentially affecting HRV. Spearman’s correlation coefficient was used to assess level of correlation between study variables. Level of statistical significance was kept at p <. 05.
Results: Severity of AUD significantly correlated with reduced HRV (r= -0.310, p=0.041). Age of onset of alcohol use also showed weak correlation (r= -0.271; p=0.05) while the severity of depression did not show a significant correlation (r= 0.124; p=0.422). Hierarchical regression analysis showed that impact of confounding factors such as age, BMI, and nicotine use insignificant (R2 change= 0.079; p=0.845).
Conclusion: HRV may be an indicator of a biological mechanism that contributes to dysfunctional physiological state in those with AUD. It needs to be further explored how affective symptoms impact the impaired inhibitory mechanisms associated with low HRV in these individuals.
Keywords: Alcohol use disorder, heart-rate
Efficacy and safety of repeated ketamine infusion in major depressive disorder with suicidal ideation.
Shri Gopal Goyal, KK Verma, Ripu Daman Singh, Girish Chandra
Department of Psychiatry (DIMHANS), PBM Hospital, Sardar Patel Medical College, Bikaner
Introduction: Major depressive disorder is a serious illness. Without treatment an episode may continue with symptoms becoming increasingly more serious. Major depressive episodes may lead a person to feel that life is not worth living and to commit suicide. Close to 800 000 people die due to suicide every year. So an urgent intervention is required to solve the crisis. As evident by previous studies, Ketamine infusion was known to be effective treatment in depression with suicidal ideation and repeated infusion having higher response rate than single infusion. With this rationale, we planned a study to see efficacy and safety of repeated infusion in such patients.
Methods and Materials: This was a single center, prospective, open-label study. After applying inclusion and exclusion criteria 20 patients were recruited and ketamine was infused @ 0.5mg/kg over 60 min under guidance of anaesthetist. Various scales like MADRS, CGI, SSI, BPRS and CADSS were applied to see efficacy and safety of infusion before and after every infusion and mean scores were compared with appropriate statistics.
Results: Repeated infusion of ketamine was effective in reducing the MADRS and SSI scores when compared to baseline scores. Endpoint MADRS score for all patients was 13.10 ±6.47, its difference with baseline score was found highly significant (t=15.89; p=0.001). Endpoint SSI for all patients was 0.50±1.08, its difference with baseline score found highly significant (t=25.99; p=0.001).
Conclusions: Ketamine seems to have a high potential in acutely reducing the suicidal ideation in patients with major depressive disorder.
Key words: MDD, Suicidal ideation, MADRS, Ketamine, NMDA