10 research outputs found
The story of Prosenjit Poddar
No full textThe concept of "Tarasoff duty" is familiar to mental health professionals. Entwined with the name of Tarasoff, is that of Prosenjit Poddar, the other important character in the story which led to the courts giving directions for mental health professionals with regard to their duty of warn. Prosenjit Poddar killed Tatiana Tarasoff when his advances toward her were rebuffed. However, the court ruled that the mental health professional who was treating Poddar and was in knowledge of his intentions to harm Tarasoff, did not take adequate measures to warn the potential victim. This led to courts laying statutes for warning the potential victims by mental health professionals when their clients disclose such threats. However, the ruling has been a matter of debate about when to take any threat seriously and how to tread cautiously given the therapist-client privilege. The case of Prosenjit Poddar throws light on complex issues related to balancing confidentiality and potential harm to others
Effects of citral, a naturally occurring antiadipogenic molecule, on an energy-intense diet model of obesity
No full textObjectives: Retinaldehyde inhibits adipogenesis, increases metabolic
rate, reduces weight gain, and improves tolerance to a glucose load. We
assessed the effects of citral - an inhibitor of retinaldehyde
dehydrogenase (the primary enzyme metabolizing retinaldehyde), on body
weight, glucose tolerance, fasting plasma glucose and insulin levels,
metabolic rate, adipocyte size, and morphology in a diet-induced model
of obesity. Materials and Methods: Out of the 5 groups of 6-week-old
male Sprague-Dawley rats, 4 were maintained on an energy-intense,
palatable, diet for a period of - 42 days, while 1 served as the
control. After obesity had been induced, 3 groups were treated with
daily doses of citral (10, 15, and 20 mg/kg body weight) for a period
of 28 days. They were then subjected to metabolic experiments. Body
weight, fasting plasma glucose, glucose tolerance to an intraperitoneal
glucose load, metabolic rate, and adipocyte size were assessed.
Results: Citral-treated groups showed a dose-dependent reduction in
body weight gain. They significantly had lower fasting glucose levels,
improved glucose tolerance, lower fasting plasma glucose, higher
metabolic rate, and smaller adipocytes after drug administration.
Conclusion: The findings suggest that citral increased energy
dissipation (and also reduced lipid accumulation) consequently
preventing and ameliorating diet-induced obesity. In addition it
improved insulin sensitivity and glucose tolerance. In the current
scenario of increasing prevalence of obesity and diabetes, citral may
prove as novel agent in its management
Effects of citral, a naturally occurring antiadipogenic molecule, on an energy-intense diet model of obesity
No full textObjectives: Retinaldehyde inhibits adipogenesis, increases metabolic
rate, reduces weight gain, and improves tolerance to a glucose load. We
assessed the effects of citral - an inhibitor of retinaldehyde
dehydrogenase (the primary enzyme metabolizing retinaldehyde), on body
weight, glucose tolerance, fasting plasma glucose and insulin levels,
metabolic rate, adipocyte size, and morphology in a diet-induced model
of obesity. Materials and Methods: Out of the 5 groups of 6-week-old
male Sprague-Dawley rats, 4 were maintained on an energy-intense,
palatable, diet for a period of - 42 days, while 1 served as the
control. After obesity had been induced, 3 groups were treated with
daily doses of citral (10, 15, and 20 mg/kg body weight) for a period
of 28 days. They were then subjected to metabolic experiments. Body
weight, fasting plasma glucose, glucose tolerance to an intraperitoneal
glucose load, metabolic rate, and adipocyte size were assessed.
Results: Citral-treated groups showed a dose-dependent reduction in
body weight gain. They significantly had lower fasting glucose levels,
improved glucose tolerance, lower fasting plasma glucose, higher
metabolic rate, and smaller adipocytes after drug administration.
Conclusion: The findings suggest that citral increased energy
dissipation (and also reduced lipid accumulation) consequently
preventing and ameliorating diet-induced obesity. In addition it
improved insulin sensitivity and glucose tolerance. In the current
scenario of increasing prevalence of obesity and diabetes, citral may
prove as novel agent in its management
Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment- and Electroconvulsive Therapy-Refractory Mania: Old Horse, New Trick
No full textA 22-year-old male diagnosed with bipolar affective disorder presented to us with a 3rd episode mania resistant to both olanzapine and haloperidol as well as electroconvulsive therapy. He, however, responded to chlorpromazine (CPZ) which was also effective as a mood stabilizer. The patient had a relapse of his illness when CPZ was stopped and responded again when it was started. The case demonstrates that CPZ may have a role in as both an anti-manic agent and for the maintenance for bipolar disorders. The possible underlying mechanism for this role is also discussed
A Survey of Medication Diffusion and Attitudes Among Indian Clinicians Toward Pharmacotherapies for Alcohol Use Disorder
No full textIntroduction: Alcohol use disorder (AUD) is a significant cause of morbidity and mortality globally. However, uptake of AUD pharmacotherapies among clinicians has remained low. There exists a research gap regarding clinician attitudes and the diffusion of AUD pharmacotherapies among Indian clinicians. We conducted a survey to assess the same. Methods: An online survey was sent to clinicians nationwide from February and April 2023 to assess attitudes and practices regarding various AUD medications. Logistic and ordinal regression models evaluate the clinician and caseload factors determining medication diffusion and attitudes. Results: A total of 387 clinicians responded to our survey. Most of them were males (61.7%) and trained psychiatrists (56.3%). The diffusion for acamprosate, naltrexone, and disulfiram was 69.8%, 81.4%, and 58.2%, respectively. Baclofen had the highest diffusion. Female respondents had significantly lower perceived efficacy, acceptability, and safety for disulfiram. Independent practitioners were more likely to prescribe all pharmacotherapies except baclofen. Discussion: Diffusion for alcohol pharmacotherapies was incomplete. Baclofen had the highest diffusion, probably reflecting its cost and safety profile. Despite its perceived efficacy, safety concerns impacted the diffusion of disulfiram. Female clinicians had lower perceived attitudes toward disulfiram. Specific training for AUD pharmacotherapies is warranted for female clinicians and nonpsychiatrists
Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: comparison of clinical and microbiological criteria
No full textIntroduction: Bacterial vaginosis is a polymicrobial syndrome involving replacement of normal vaginal hydrogen peroxide producing lactobacilli by a variety of mycoplasmas and Gram-negative rods. Bacterial vaginosis has been conventionally diagnosed using Amsel criteria (a clinical method) or Nugent's score (a laboratory method with higher reproducibility). This study was undertaken to compare the diagnostic ability of the Amsel criteria with that of Nugent's score among patients presenting with abnormal vaginal discharge. Methodology: The study was conducted at the Medical College in Kolkata, India to determine the prevalence of patients with bacterial vaginosis and their demographic profile. Subjects attending the outpatient department presenting with abnormal vaginal discharge were evaluated for the presence of bacterial vaginosis by Amsel criteria and Nugent's score. Results: Prevalence of bacterial vaginosis was 24% by Nugent's score. In comparison, Amsel criteria had sensitivity of 66.67%, specificity of 94.74%, positive predictive value of 80% and negative predictive value of 90%. There was no perfect inter-rater agreement between the Amsel criteria and Nugent's score (Kappa = 0.58). Presence of clue cells correlated best with a positive diagnosis by Nugent's score while the amine test (whiff test) had the lowest correlation. Conclusion: Although the Amsel criteria method is a convenient and inexpensive means of diagnosing bacterial vaginosis, it is not always reliable. Alternative reliable and inexpensive diagnostic methods that unify clinical and microbiological parameters, thus increasing sensitivity while retaining specificity, are needed.</jats:p
Perceived Learning and Feedback of Students Following the Competency-based Clinical Rotation in Psychiatry: A Retrospective Review From Tertiary-care Teaching Institute in Central India
No full textBackground: Competency-based medical education (CBME) offers avenues for effective psychiatry teaching to medical students. However, data concerning the feasibility, effectiveness, and students’ perspectives on CBME-based clinical rotation, including psychiatry, needs to be explored in India. Therefore, this research aims to evaluate the student’s learning effectiveness and feedback on the CBME-informed psychiatry posting. Methods: This cross-sectional retrospective research evaluated the 7th-semester MBBS students (n = 101, 39 [38.6%] females and 62 [71.4%] males), from a tertiary-care teaching hospital in central India, perceived change in Knowledge, Attitude, and Skill and feedback on the CBME-based clinical rotation (July-December 2023) using a mixed-method approach through an online feedback form. Results: A “considerable or marked perceived change,” ranging from 70% to 97%, in the knowledge, attitude, ethical aspects, psychomotor skills, and soft skills were noted. 84%–91% of students were “satisfied/quite satisfied (or rated it good to very good)” with the pattern and content of the program, including the assessment. 37% expressed their desire to take psychiatry as an elective. Descriptive responses showed that participants felt improvement in their communication skills, knowledge about non-pharmacological interventions, opportunity to observe and present cases in the Outpatient Department, and satisfaction with the teaching and assessment methods. The need for minor changes regarding case-based formative assessment and the opportunity for more case workups were also cited. Conclusion: The CBME-informed psychiatry clinical rotation can be instrumental in improving psychiatry training and promoting mental health among students. Research involving a comparison arm, longitudinal design, and validated assessment tools can bring greater insights into the subject
Surreptitious Administration of Disulfiram Along with Its Implantation Leading to Disulfiram-associated Encephalopathy
No full textDesigning smartphone-based cognitive assessments for schizophrenia: Perspectives from a multisite study
No full textIntroduction: Cognitive deficits represent a core symptom of schizophrenia and a principal contributor to illness disability, yet evaluating cognition in routine clinical settings is often not feasible as cognitive assessments take longer than a standard doctor's visit. Using smartphones to assess cognition in schizophrenia offers the advantages of convenience in that patients can complete assessments outside of the clinic, temporality in that longitudinal trends can be identified, and contextuality in that cognitive scores can be interpreted with other measures captured by the phone (e.g. sleep). The current study aims to design a battery of cognitive assessments corresponding to the MATRICs Consensus Battery of Cognition (MCCB), in partnership with people living with schizophrenia. Methodology: Focus group discussions (FGDs) and interviews were conducted with people diagnosed with schizophrenia across three sites (Boston, Bhopal, and Bangalore) to help design, refine, and assess the proposed smartphone battery of cognitive tests on the mindLAMP app. Interviews were conducted between December 2023 and March 2024. Inductive thematic analysis was used to analyze data. Results: Participants found the app and its proposed cognitive assessments to be acceptable, helpful, and easy to use. They particularly found the gamified nature of the cognitive tests to be appealing and engaging. However, they also proposed ways to further increase engagement by including more information about each cognitive test, more visual instructions, and more information about scoring. Across all sites, there were many similarities in themes. Discussion & conclusion: People living with schizophrenia, from different sites in the US and India, appear interested in using smartphone apps to track their cognition. Thematic analysis reinforces the importance of feedback and data sharing, although this presents a challenge, given the novel nature of smartphone-based cognitive measures that have not yet been standardized or validated
Optimizing treatment for depression in primary care using psychotherapy versus antidepressant medication in a low-resource setting: protocol for the OptimizeD randomized controlled trial
No full textBackground: Psychotherapy and antidepressant medications are first-line treatments for depression, and they both have significant treatment effects on average. However, treatment response varies widely across patients, and neither approach is universally effective. Identifying the most effective treatment for each patient is critical everywhere, but particularly in low-resource settings where access to mental health care is limited. The Optimizing Depression (OptimizeD) trial aims to explore whether different patients respond differently to behavioral activation therapy versus antidepressant medication and if providing each patient with their optimal treatment improves outcomes in primary care. Methods: We plan to randomize 1,500 patients with moderate to severe depression (defined as a Patient Health Questionnaire [PHQ-9] score ≥ 10) from primary healthcare settings in Bhopal, India, with equal allocation either to a culturally adapted behavioral activation therapy delivered by trained counselors (Healthy Activity Program) or to antidepressant medication (fluoxetine). Treatment will last 3 months, with remission (defined as PHQ-9 score < 5) at 3 months as the primary endpoint. Using machine learning, we will attempt to develop a precision treatment rule that leverages baseline clinical, psychological, cognitive, socioeconomic, and biological data to predict which treatment is most likely to achieve remission for each patient. Cost-effectiveness analysis will then assess whether the added costs of optimizing treatment are justified by improvements in remission, recovery, and cost savings at the health system and societal levels. Secondary and exploratory objectives include assessing the effectiveness of optimization in a range of secondary outcomes, evaluating treatment mechanisms, and exploring whether incorporating genetic and biological markers as predictors improves treatment optimization. Discussion: The OptimizeD trial will evaluate whether baseline information collected in routine care can inform optimal depression treatment selection and identify predictors of nonresponse to facilitate timely specialist referrals. Findings have the potential to enhance personalized depression care in primary health systems, particularly in low-resource settings, with broader implications for global public health. Trial registration: ClinicalTrials.gov (NCT05944926; registered July 2, 2023) and Clinical Trials Registry India (CTRI/2024/01/061932; registered January 29, 2024)
