Indian Journal of Psychiatry最新文献

{"title":"Depression, diabetes, and digitally governed integrated public mental health services.","authors":"Deby F Eprilianto, Yuyun E K Sari","doi":"10.4103/indianjpsychiatry_661_26","DOIUrl":"10.4103/indianjpsychiatry_661_26","url":null,"abstract":"","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"861-862"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presumptive false-positive amphetamine urine screen in a pregnant woman receiving α-methyldopa: A case report.","authors":"Ömer Naim Sayer, Gamze Baytar, Hülya Kılıç, Koray Soytürk","doi":"10.4103/indianjpsychiatry_1206_25","DOIUrl":"10.4103/indianjpsychiatry_1206_25","url":null,"abstract":"","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"865-867"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of comprehensive targeted intervention (TI) services among persons who inject drugs (PWIDs) in Himachal Pradesh.","authors":"Dinesh Kumar, Sunil Raina","doi":"10.4103/indianjpsychiatry_1012_25","DOIUrl":"10.4103/indianjpsychiatry_1012_25","url":null,"abstract":"<p><strong>Background: </strong>This study emphasized the necessity of evaluating both covered and non-covered People Who Inject Drugs (PWIDs) to identify implementation issues and enhance service delivery. The objective was to assess the availability and accessibility of Targeted Intervention (TI) services and factors influencing their implementation.</p><p><strong>Methods: </strong>A mixed-methods study was conducted from September 2024 through March 2025, utilizing a cross-sectional survey (of both TI and non-TI PWID) alongside focus group discussions (FGDs).</p><p><strong>Results: </strong>Quantitative data were collected from 646 PWID (TI: 454; non-TI: 192), complemented by 10 FGDs. The participants' mean age was 28 years, with a mean age of initiation for substance use at 22 years. PWID enrolled in TIs were significantly more likely to reside in their home districts, inhabit urban areas, and be engaged in small-scale business. Although TI-enrolled participants showed higher rates of human immunodeficiency virus (HIV) awareness, testing, and access to sterile needles/syringes, overall coverage remained low for Opioid Substitution Therapy (OST), routine screenings for sexually transmitted infections/reproductive tract infections (STIs/RTIs), and consistent condom use. Narrative analysis revealed general satisfaction with existing services but highlighted a critical demand for localized OST, expanded needle/syringe access, and vocational rehabilitation.</p><p><strong>Conclusions: </strong>Coverage of TI services was better for HIV testing and fresh needles/syringes. TI services need to be strengthened and expand their coverage for OST, improving local access to needles/syringes, and sexual health services (RTIs/STDs and condom programming). TI program should also devise a mechanism to engage non-TI PWIDs to provide services.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"784-790"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Add-on intravenous ketamine eliminates treatment lag period in severe non-treatment-resistant major depression: Rapid antidepressant and anti-suicidal effects - A randomized controlled trial.","authors":"Anand Prakash, Pranab Mahapatra, Jigyansa I Pattnaik, Udit K Panda, Sudipta K Das","doi":"10.4103/indianjpsychiatry_845_25","DOIUrl":"10.4103/indianjpsychiatry_845_25","url":null,"abstract":"<p><strong>Background: </strong>The 4-12 week lag period of conventional antidepressants creates critical vulnerability in severe depression, with peak suicide risk during the first month. While ketamine research has focused on treatment-resistant populations, its potential to eliminate this lag period in non-treatment-resistant severe depression remains unexplored.</p><p><strong>Aims: </strong>To evaluate whether add-on intravenous ketamine eliminates the treatment lag period in severe non-treatment-resistant major depressive disorder and assess rapid antidepressant and anti-suicidal effects.</p><p><strong>Methods: </strong>A randomized, double-blind, placebo-controlled trial was conducted at a tertiary care hospital from October 2020 to September 2022. Forty patients with severe MDD (HAM-D ≥19) received either ketamine (0.5 mg/kg IV, n = 19) or placebo (n = 21) as add-on therapy over 4 infusions on days 1, 3, 5, and 8. The primary outcome was ≥50% HAM-D reduction at day 12. Secondary outcomes included suicidal ideation using the Beck Scale for Suicidal Ideation (BSSI) and global functioning improvement.</p><p><strong>Results: </strong>Primary response rate was 58% versus 29% in placebo (<i>P</i> < 0.05), yielding a number needed to treat of 3.4. Significant HAM-D improvement occurred from day 2 onwards (<i>P</i> < 0.05). Complete suicidal ideation resolution occurred by day 5 in the ketamine group versus persistent ideation in placebo (<i>P</i> < 0.001). Patients with anxiety features showed 0% treatment completion versus 93% in non-anxious patients. Effects were sustained at 4-week follow-up.</p><p><strong>Conclusions: </strong>This pilot randomized controlled trial provides preliminary evidence for rapid antidepressant and anti-suicidal effects of add-on intravenous ketamine in severe non-treatment-resistant major depression; findings require confirmation in an adequately powered trial.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"776-783"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of clozapine trough level reporting in clinical practice: A four-year retrospective evaluation from India.","authors":"Amol N Patil, Pankaj Khatri, Sunil Sharma, Smita Pattanaik, Subho Chakrabarti, Yogesh Dan Charan, Namrata Singh, Alisha Kashyap, Sandeep Grover","doi":"10.4103/indianjpsychiatry_375_26","DOIUrl":"10.4103/indianjpsychiatry_375_26","url":null,"abstract":"<p><strong>Background: </strong>Clozapine therapeutic drug monitoring (TDM) supports individualized dosing in treatment-resistant schizophrenia.</p><p><strong>Aim: </strong>This study evaluated the time trend of TDM reporting in routine practice.</p><p><strong>Methods: </strong>A retrospective audit of 100 consecutive clozapine TDM reports over 4 years was performed. Service utilization was assessed. Associations between daily dose, trough concentration, concentration-dose (C/D) ratio, therapeutic impressions (low, matching the dose, high, very high clozapine concentrations), and clinical advice accordingly were analyzed statistically.</p><p><strong>Results: </strong>The mean turnaround time was 20.9 ± 12 days, with a stable quarterly demand (~6 requests/quarter) for clozapine TDM. Dose correlated significantly with trough concentration (ρ = 0.453, <i>P</i> < 0.001). Forty-seven percent of concentrations were subtherapeutic. C/D ratio differed significantly between therapeutic impressions (β = 13.12, <i>P</i> < 0.001). Therapeutic impressions significantly influenced clinical advice (χ² = 54.03, <i>P</i> < 0.001). Nonadherence was identified in 8% of cases.</p><p><strong>Conclusions: </strong>Pharmacology TDM service utilization for clozapine was steady and continuing in treatment-resistant schizophrenia patient care.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"826-830"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An exploratory factor analysis of Telugu versions of the WHO well-being index, the UCLA-loneliness scale and the perceived criticism scale in caregivers of schizophrenia patients.","authors":"S Lakshmi, Mamidipalli S Spoorthy, Barikar C Malathesh, Sangha M Godi, Raj K Donthu, Vullanki S Sreeja, Sandeep Grover, Sai K Tikka","doi":"10.4103/indianjpsychiatry_273_26","DOIUrl":"10.4103/indianjpsychiatry_273_26","url":null,"abstract":"<p><strong>Background: </strong>The lack of locally validated instruments hinders proper evaluation and management of caregiver burden.</p><p><strong>Aim: </strong>To perform an exploratory factor analysis (EFA) of Telugu-translated scales assessing psychological factors related to caregiver burden.</p><p><strong>Methods: </strong>This cross-sectional study was conducted at three sites: Among 100 caregivers of schizophrenia patients using Telugu-translated versions of the WHO Well-being Index (WHO WBI), the UCLA Loneliness Scale (ULS), and the Perceived Criticism Scale (PCS). EFA was used to identify the factor structure.</p><p><strong>Results: </strong>Principal component analysis revealed that the items of the scales- WHO-WBI, ULS, and PCS were significantly loaded on one factor each, with eigenvalues of 3.810, 2.504, and 2.105, respectively, and the substantive factors represent \"mood\", \"loneliness\", and \"criticism\", respectively. Cronbach's α coefficient was 0.9 for WHO-WBI and ULS, and 0.78 for PCS, indicating an acceptable level of internal consistency.</p><p><strong>Conclusion: </strong>Telugu versions of WHO-WBI, ULS, and PCS hold fair-to-good structural validity and internal consistency.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"831-834"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A conceptual framework for the diagnostic pathology of anxiety disorders: Clinical and pathological tetrads for identifying pathological anxiety.","authors":"Narayana Manjunatha","doi":"10.4103/indianjpsychiatry_734_26","DOIUrl":"10.4103/indianjpsychiatry_734_26","url":null,"abstract":"<p><p>Anxiety disorders (ADs) are among the most prevalent psychiatric conditions and contribute substantially to disability, healthcare burden, and impaired quality of life. However, current diagnostic systems rely primarily on descriptive psychopathology and symptom-based classifications, providing limited guidance for distinguishing adaptive from pathological anxiety during clinical assessment. The aim is to propose a Diagnostic Pathology Framework for ADs that operationalizes the distinction between adaptive and pathological anxiety using clinically identifiable markers. This conceptual paper proposes three interrelated constructs. <i>First</i>, the 3R's Framework conceptualizes anxiety as the Receipt of stimuli, automatic Reactions, and consciously regulated Responses. <i>Second</i>, anxiety is viewed as an adaptive survival reaction expressed through four domains: worry, fear, arousal, and avoidance. <i>Third</i>, pathological anxiety is operationalized using the Clinical Tetrad comprising Temporal pattern, Intensity, Proportionality, and Controllability (TIP-C) which serves as clinical markers for identifying pathology. Framework characterizes the diagnostic pathology of ADs through a Pathological Tetrad comprising pathological worry, pathological fear, pathological arousal, and pathological avoidance. These are further sub-classified into generalized/focal pathological worry, interoceptive/exteroceptive pathological fear, tonic/phasic pathological arousal, and in-situ/ex-situ pathological avoidance. Clinical Tetrad operationalizes the identification of Pathological Anxiety (PA), while the Pathological Tetrad characterizes its principal manifestations across ADs. The proposed Framework complements descriptive psychopathology by introducing operational clinical markers for identifying PA. By integrating TIP-C Clinical Tetrad with the Pathological Tetrad, it provides a clinicopathological approach that may enhance diagnostic reasoning, medical education, and future research. Further studies are required to establish its reliability, validity, and clinical utility across diverse clinical settings.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"841-847"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impulsivity, emotional dysregulation, aggression, and hopelessness in suicide attempts among bipolar disorder patients: A cross sectional study.","authors":"Simran Sandhu, Koustubh R Bagul, Muskan Gulani, Varchasvi Mudgal, Priyash Jain","doi":"10.4103/indianjpsychiatry_699_26","DOIUrl":"10.4103/indianjpsychiatry_699_26","url":null,"abstract":"<p><strong>Background: </strong>Suicide attempts are common in bipolar affective disorder (BPAD), but the contribution of enduring psychological traits to suicidal behavior during remission remains unclear.</p><p><strong>Aim: </strong>To compare impulsivity, aggression, emotional dysregulation, and hopelessness between remitted BPAD patients with and without a lifetime history of suicide attempts, and to identify independently associated factors of suicidal behavior.</p><p><strong>Materials and methods: </strong>This cross-sectional comparative study included 150 remitted BPAD patients recruited from a tertiary-care psychiatry center in India. Participants were divided into suicide-attempt (n = 72) and non-attempt (n = 78) groups. The sample included 86 females and 64 males. Trait variables were assessed using the Barratt Impulsiveness Scale-11, Buss-Perry Aggression Questionnaire, Difficulties in Emotion Regulation Scale, and Beck Hopelessness Scale.</p><p><strong>Results: </strong>Patients with a lifetime history of suicide attempts had significantly higher impulsivity, aggression, and emotional dysregulation scores compared to non-attempters (all <i>P</i> < 0.001). Hopelessness scores were also higher among suicide attempters (<i>P</i> = 0.050). Logistic regression analysis identified impulsivity (OR = 1.05, 95% CI: 1.02-1.08, <i>P</i> < 0.001) and emotional dysregulation (OR = 1.03, 95% CI: 1.01-1.05, <i>P</i> = 0.002) as independently associated with suicide attempts, whereas aggression and hopelessness were not independently associated.</p><p><strong>Conclusion: </strong>Impulsivity and emotional dysregulation appear to represent important trait-related vulnerabilities associated with suicide attempts in patients with remitted BPAD. Incorporating assessment of these dimensions into routine clinical evaluation may improve long-term suicide prevention strategies in bipolar disorder.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"815-820"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding caregivers' perspectives on adolescent psychiatric admission and re-admission.","authors":"Dikshita Baruah, Radhakrishnan Govindan, John V S Kommu, K Annapoorani","doi":"10.4103/indianjpsychiatry_671_25","DOIUrl":"10.4103/indianjpsychiatry_671_25","url":null,"abstract":"<p><strong>Background: </strong>In India, adolescent psychiatric hospitalization is influenced by clinical, familial, and systemic factors. Caregivers' perspectives on admission decisions remain underexplored, particularly in low-resource settings.</p><p><strong>Aim: </strong>To explore the perceived need for inpatient admission or re-admission of adolescents with mental illness, as expressed by their primary caregivers.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted at a tertiary Child and Adolescent Psychiatric Centre in India. Twenty-six primary caregivers of adolescents (13-18 years) were interviewed using a validated semi-structured guide, and the data were analyzed thematically.</p><p><strong>Results: </strong>Thematic analysis identified several themes: factors influencing admission/re-admission, caregiver burden, family and home dynamics, social withdrawal and inadequate school support, adolescent coping strategies, and treatment-related challenges such as medication side effects and inadequate aftercare.</p><p><strong>Conclusion: </strong>Caregiver-perceived admission drivers are multifactorial. Strengthening community services, caregiver psychoeducation, and adolescent-friendly aftercare is essential to reduce preventable hospitalisations.</p>","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"835-838"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond helplines and programmes: What the union budget 2026 means for mental healthcare in India.","authors":"Vikram Seggam","doi":"10.4103/indianjpsychiatry_145_26","DOIUrl":"10.4103/indianjpsychiatry_145_26","url":null,"abstract":"","PeriodicalId":13345,"journal":{"name":"Indian Journal of Psychiatry","volume":"68 9","pages":"839-840"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}