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This article discusses the use of formative assessments in postgraduate medical education in India, specifically in General Hospital Psychiatry Units (GHPUs). Formative assessments are low-stakes evaluations that help students identify their strengths and weaknesses. The article describes various formative assessment strategies used in GHPUs, including logbooks, assessment of academic activities, work-based assessments, internal assessments exams, and 360° evaluations. These assessments are used to provide feedback to trainees and track their progress. The article also highlights the challenges and potential benefits of using graphical projections to visualize trainees' progress. [Extracted from the article]

Background: Substance use disorders (SUDs) are among the leading causes of morbidity in the population. In low- and medium-income countries like India, there is a wide treatment gap for SUD. A multicentric study on the care pathways for SUD in India can help to understand service provision, service utilization, and challenges to improve existing SUD care in India. Aim: We aimed to map pathways to care in SUD. We compared the clinical and demographic characteristics of patients who first consulted specialized services versus other medical services. Methods: This was a cross-sectional study of consecutive, consenting adults (18-65 years) with SUD registered to each of the nine participating addiction treatment services distributed across five Indian regions. We adapted the World Health Organization's pathway encounter form. Results: Of the 998 participants, 98% were males, 49.4% were rural, and 20% were indigenous population. Addiction services dominated initial (50%) and subsequent (60%) healthcare contacts. One in five contacted private for-profit healthcare. Primary care contact was rare (5/998). Diverse approaches included traditional healers (4-6%) and self-medication (2-8%). There was a 3-year delay in first contact; younger, educated individuals with opioid dependence preferred specialized services. Conclusion: There is a need to strengthen public healthcare infrastructure and delivery systems and integrate SUD treatment into public healthcare. [ABSTRACT FROM AUTHOR]

Background: Psychiatric disorders are among the leading contributors to disability in India and worldwide. The pattern, prevalence, and distribution of psychiatric disorders in the country and its regions need to be assessed to facilitate early diagnosis and treatment. No study on the epidemiology of psychiatric disorders has been conducted in the Chhattisgarh state. This paper, as part of the National Mental Health Survey (NMHS), discusses the prevalence and pattern of psychiatric disorders in Chhattisgarh state. Methods: A stratified random cluster sampling technique and random selection based on probability proportional to size (PPS) at each stage were adopted. Participants were from three selected districts of Chhattisgarh, such as Janjgir-Champa, Kabirdham, and Raipur. Adults (aged ≥18 years) residing in selected households were interviewed using Mini International Neuropsychiatric Interview (version 6.0), the Fagerstrom test for nicotine dependence, the WHO-SEARO screening questionnaire for generalized tonic-clonic seizures, and screening tools for intellectual disability and autism spectrum disorders. Results: A total of 2841 individuals were interviewed. The state's lifetime and current prevalence of psychiatric disorders for adults were 14.06% [95% confidence interval (CI) = 13.83–14.29] and 11.66% (95% CI = 11.45–11.87), respectively. Prevalence of substance use disorders, tobacco use disorders, schizophrenia and related disorders, and mood disorders was 32.4% (95% CI = 32.09–32.71), 29.86% (95% CI = 29.56–30.16), 0.8% (95% CI = 0.75–0.86), and 4.44% (95% CI = 4.31–4.58), respectively. High risk for suicide was detected in 0.28% (95% CI = 0.25–0.31). Psychiatric disorders were twice more common in males than in females. Conclusions: The study gives authentic data on the prevalence of psychiatric disorders in Chhattisgarh. This shall pave the way for policymakers and planners to design state-specific plans for dealing with mental disorders and related issues. [ABSTRACT FROM AUTHOR]

Background: There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle. Aim: This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India. Method: A retrospective case file study was conducted across several centers in India. Results: Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer's disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions. Conclusions: Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided. [ABSTRACT FROM AUTHOR]

Background: Internet use has spread across the world due to easy accessibility and affordability. However, it has been creating many problems at several levels. So, there is a need to identify the suitability of psychometric properties and the factor structure of the widely used Internet Addiction Test (IAT) in the Indian settings. Our objective was to perform an exploratory factor analysis on the IAT and to test the reliability of the scale. Methods: It was a cross-sectional study that included various professional groups. We used an online questionnaire that included sociodemographic details and Young's IAT. Exploratory factor analysis was used to identify the factor structure of Young's IAT in the Indian setup. Results: The mean age of the sample (N = 1,782) was 27.7 years (SD = 8.74) with a predominantly male population 1040 (58.4%). In total, 1.0% (17) of the sample had significant problems with internet usage, whereas 13% (232) were in the range of frequent/occasional problems, and the mean score on IAT was 32 (SD = 16.42). Exploratory factor analysis revealed two factors that explained 49% of the variance (Kaiser–Meyer–Olkin measure of sampling adequacy: 0.95, Bartlett's test of sphericity: P = 0.000). They were "mood and relationship issues" and "duration and productivity." Cronbach's α was 0.92, which indicates a high level of internal consistency. Conclusion: In Indian settings, IAT can be understood based on the two-factor structure. The scale has excellent reliability. Further studies are needed to replicate these results, by using confirmatory factor analysis and validity testing. [ABSTRACT FROM AUTHOR]

Background: Previous attempts of Mental Health Systems Assessment in India were restricted in scope and scale. Information on all aspects of mental health systems (leadership/governance, legislation, financing, service delivery, workforce, access to essential medicines, information systems, intersectoral activities, and monitoring and evaluation) was scarcely available. The National Mental Health Survey-Mental Health Systems Assessment (NMHS-MHSA), a unique endeavor, assessed the performance of mental health systems and services through health systems assessment framework. The present paper discusses the design and methodology adopted under NMHS-MHSA along with emphasizing its implication for India and other LMICs. Methods: NMHS-MHSA was undertaken in 12 Indian states by contextually adapting WHO-AIMS instrument. Data was collated from several secondary sources including interviews of key stakeholders. Utilizing the data a set of 15-quantitative, 5-morbidity and 10-qualitative indicators were developed to summarize the functional status of mental health systems in the surveyed states. This information was authenticated through state level stakeholder's consultation and consensus building workshops following which a state mental health systems report card with indicators was developed. Conclusion: The process and robust method of data compilation enabled NMHS-MHSA to be a reliable and comprehensive method for assessing mental health systems at the state level. It's envisaged that the assessment provides requisite impetus for strengthening mental health program and mental health systems in India. Being less resource intensive, low -and middle- income countries can adopt NMHS-MHSA tool and methodology to assess their mental health systems with contextual modifications. [ABSTRACT FROM AUTHOR]

Staying home is NOT "staying safe": A rapid 8-day online survey on spousal violence against women during the COVID-19 lockdown in India , the nationwide lockdown in India began on the 25 March 2020 in a quest to fight the COVID-19 pandemic. This survey was conducted between 11 and 18 May 2020 (lockdown Phase 3 ended 17 May 2020). [Extracted from the article]

In patients presenting with manic symptoms and history of opioid use, clinicians should consider the possibility of withdrawal emergent manic symptoms, which might rapidly resolve with opioid substitution alone. He was diagnosed as having opioids-dependence syndrome, with harmful use of sedatives or hypnotics, uncomplicated withdrawal state, and withdrawal emergent mania with psychotic symptoms. This association has been reported to be threefold to fourfold higher for opioid use disorders compared to other substances.[1] Both opioids-induced and withdrawal emergent mania are not reported frequently and, therefore, less understood. [Extracted from the article]

A letter to the editor is presented regarding High Density Lipoprotein concentration during dependence states of alcoholism.

Background and Aim: Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence., Materials and Methods: A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24-April 14) and the second phase (April 15-May 3) of lockdown., Results: A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid., Conclusion: Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Psychiatry.)

Background: The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions., Materials and Methods: We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June-September) of the pandemic., Results: An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ 2 = 20.408, P = 0.000), make attempts (χ 2 = 12.436, P = 0.000), seek treatment ( χ 2 = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ 2 = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ 2 = 35.143, P = 0.000) and experience stigma by family members (χ 2 = 29.951, P = 0.000) and neighbors (χ 2 = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others., Conclusion: COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Psychiatry.)

Competing Interests: There are no conflicts of interest.

Coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are treatments of choice for coronary artery disease. Quality of life (QoL) is an important factor in determining optimum treatment. This study was aimed to compare changes in QoL, six months post procedure, between CABG and PTCA, and to understand the confounding effect of various contributing factors. Thirty stable angina patients each in CABG and PTCA groups, were followed up for six months. QoL was assessed with WHO-QoL-BREF. Depression was rated on the Hamilton Depression Rating Scale. Changes in QoL and depression within and between CABG and PTCA groups were compared. Multinomial logistic regression was used to measure the predictive strength of treatment type (CABG and PTCA) on QoL, controlling for significant confounders. Although scores of QoL and depression significantly changed over time in both the groups, time×group interaction did not reach to a significance. Significant confounding effects of diabetes (P<0.01), hypertension (P<0.05) and diet restriction (P<0.05) were found. Controlling for confounding effects of these factors, group distribution to PTCA, compared to CABG, significantly predicted greater improvements in QoL (P<0.01)., Competing Interests: None

Background: Interview-based schizophrenia (SCZ) diagnostic methods are not completely valid. Moreover, SCZ-the disease entity is very heterogeneous. Supervised-Machine-Learning (sML) application of Artificial-Intelligence holds a tremendous promise in solving these issues., Aims: To sML-based discriminating validity of resting-state electroencephalographic (EEG) quantitative features in classifying SCZ from healthy and, positive (PS) and negative symptom (NS) subgroups, using a high-density recording., Settings and Design: Data collected at a tertiary care mental-health institute using a cross-sectional study design and analyzed at a premier Engineering Institute., Materials and Methods: Data of 38-SCZ patients and 20-healthy controls were retrieved. The positive-negative subgroup classification was done using Positive and Negative Syndrome Scale operational-criteria. EEG was recorded using 256-channel high-density equipment. Eight priori regions-of-interest were selected. Six-level wavelet decomposition and Kernel-Support Vector Machine (SVM) method were used for feature extraction and data classification., Statistical Analysis: Mann-Whitney test was used for comparison of machine learning-features. Accuracy, sensitivity, specificity, and area under receiver operating characteristics-curve were measured as discriminatory indices of classifications., Results: Accuracy of classifying SCZ from healthy and PS from NS SCZ, were 78.95% and 89.29%, respectively. While beta and gamma frequency related features most accurately classified SCZ from healthy controls, delta and theta frequency related features most accurately classified positive from negative SCZ. Inferior frontal gyrus features most accurately contributed to both the classificatory instances., Conclusions: SVM-based classification and sub-classification of SCZ using EEG data is optimal and might help in improving the "validity" and reducing the "heterogeneity" in the diagnosis of SCZ. These results might only be generalized to acute and moderately ill male SCZ patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Psychiatry.)

Gorham-Stout disease (GSD) is a rare bone disease of unknown etiology, characterized by spontaneous and progressive resorption of bones. This disease occurs most commonly in males of the age group of fewer than 40 years and has no genetic predisposition. It most commonly affects the skull, spine, pelvis and shoulder girdle. The diagnosis of GSD is established based on the combination of clinical, radiologic, and histological features, after excluding other diseases. There is no standard treatment for it so far, and the therapy depends on patient's clinical condition and may include surgery, radiotherapy, and drugs, with varying degrees of success. To the best of our knowledge such involvement of hip and its treatment by a megaprosthesis, in an elderly lady by GSD has not been reported. This case report describes an unusual presentation of the disease of the hip in an elderly female successfully treated with replacement of the deficient proximal femur by using a bipolar hip mega prosthesis of the hip (XLO, India)., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: The likelihood of the relation between Internet overuse and comorbid psychiatric conditions is on the rise. However, sleep disturbances are common psychiatric symptoms associated with internet overuse. Our objective was to examine the association of Internet overuse with excessive daytime sleepiness, sleep problems in professionals from India., Materials and Methods: This was a web-based cross-sectional study through a predesigned questionnaire which included various professional groups. The information included in the questionnaire was sociodemographic details, Young's internet addiction test (IAT) and Epworth sleepiness scale (ESS)., Results: About 1.0% of total sample population had severe internet addiction whereas 13% were in the range of moderate internet addiction and the mean score on IAT was found to be 32 (standard deviation [SD] = 16.42). The mean duration of total night time sleep (5.61 ± 1.17) is significantly lower in participants with moderate and severe internet addiction (6.98 ± 1.12) compared to those with no and mild internet addiction. The mean scores of ESS were significantly higher in individuals with moderate and severe addiction (M = 10.64, SD = 4.79). We found that sleepiness while in 5 of the situations such as driving a car (χ 2 = 27.67; P < 0.001), sitting and reading (χ 2 = 13.6; P = 0.004), traveling in a car (χ 2 = 15.09; P = 0.002), afternoon rest time (χ 2 = 15.75; P = 0.001), and postlunch quiet time (χ 2 = 24.09; P < 0.001), predicted membership to moderate-to-severe internet addiction, even after controlling for the confounding effects of age and gender., Conclusions: This study shows an association between Internet overuse, excessive daytime sleepiness, and other sleep problems. Clinicians should be proactive and conscious in scrutinizing the patients for internet addiction and its consequences., Competing Interests: There are no conflicts of interest.