Background:
Persons with severe mental illness (SMI) reportedly have a high mortality rate due to metabolic syndrome (MS). However, lifestyle modification (LM) offers effective management of some ...components of MS. This study aimed to evaluate the effectiveness of LM in reducing body-weight-related parameters in SMIs.
Method:
Eighty participants with SMI were assigned randomly to either LM (n = 40) or treatment as usual (TAU; n = 40) groups using block randomization (eight blocks of n = 10). The LM group and their caregivers received a structured LM package that included nutrition counselling, recommendations on a balanced diet, and physical activity. The two groups were assessed on body weight, body mass index (BMI), waist circumference (WC), waist–hip ratio (WHR), and quality of life (QOL) at baseline and after three months. Thirty-one LM and 33 TAU participants completed the study.
Results:
The LM and TAU groups were comparable on sociodemographic and clinical characteristics and baseline variables of body weight, BMI, WC, and WHR (all P > 0.08). Repeated-measures analysis of variance (RM ANOVA) showed that the LM group had significantly reduced body weight, BMI, WC, and WHR (all P < 0.001) than the TAU group. Similarly, the LM group also showed improvement in their QOL (P < 0.001), whereas TAU showed no improvement.
Conclusions:
LM is an effective way to reduce body-weight-related parameters of MS and improves the QOL among persons with SMI in the short term. The caregivers’ inclusion during LM contributed to the weight reduction. However, the long-term effect of the intervention could not be assessed.
Individualized lifestyle interventions using motivational interviewing (MI) approach are recommended for persons with severe mental illness (SMI) for effective weight management. The aim of this ...meta-analysis was to assess the effectiveness of various lifestyle interventions that addressed obesity among persons with SMI. Twelve RCTs were assessed by individual reviewers using revised cochrane risk-of-bias tool (RoB 2). The standardized mean difference (SMD) was calculated with a 95% CI. The age of participants was between 18 and 70 years. Waist circumference showed an SMD of −0.09 (−0.22, 0.03), weight −0.03 (−0.10, 0.15) and BMI −0.07 (−0.07, 0.22). The findings in this meta-analysis revealed that though lifestyle interventions were statistically insignificant in reducing antipsychotic induced weight gain among persons with SMI, they show changes in intervention group. Psychosocial management along with lifestyle interventions, and MI are effective in the management of antipsychotic induced weight gain.
Background:
In a network meta-analysis (NMA), multiple treatments can be compared simultaneously by aggregating pieces of evidence from direct as well as indirect treatment comparisons in different ...randomized controlled trials (RCTs). Conventional NMA are performed using a normal approximation approach and can be applied for arm-level binary outcome data as well. This study aimed to estimate the treatment effects within a Bayesian framework using a binomial likelihood for a multivariate NMA model.
Methods:
The dataset consists of 57 RCTs comparing the effect of ten pharmacological drugs and a placebo for acute bipolar mania in adults. The binary outcomes of interest were treatment response and all-cause dropouts measured three weeks from the baseline. Binomial distribution was adopted for the number of events and the probability of event occurrence modeled on the logit scale. Jeffrey’s Beta prior was considered for the heterogeneity and inconsistency of standard deviation (SD) parameters. Cholesky and spherical decomposition strategies were adopted for the between-study variance–covariance matrix. Deviance information criterion (DIC) indices were computed to determine the model fit. All results pertaining to Markov chain Monte Carlo simulations and all analyses were carried out in WinBUGS software.
Results:
The estimated common heterogeneity SDs were similar, and the DIC values did not provide any evidence for superiority between the two decomposition strategies. The correlation (95% credible interval) between the outcomes was estimated as −0.31 (−0.71, −0.02) and −0.37 (−0.73, −0.03) for the Cholesky and spherical decompositions, respectively. Gelman–Rubin convergence statistics were stable, and Monte Carlo errors for all the parameters were around 0.005. Overall, olanzapine, paliperidone, and quetiapine were both significantly more effective and acceptable than a placebo when both the study outcomes were considered simultaneously.
Conclusions:
The findings favoring olanzapine, paliperidone, and quetiapine possess an excellent concordance with the one adopted in clinical practice, and the Canadian Network for Mood and Anxiety Treatments and Royal Australian and New Zealand College of Psychiatrists guidelines recommend these as first-line drugs for treating bipolar disorder.
Background:
Child sexual abuse (CSA) is known to have short and long-term consequences which can have an impact even in adulthood. The objectives of the study were to explore the nature of CSA in ...individuals attending psychiatric services, the impact of CSA on psychopathology, trauma and attachment beliefs and interpersonal functioning in young adult survivors and factors associated with CSA and its impact.
Methodology:
The study adopted a cross-sectional exploratory design. The sample comprised of 246 young adult patients attending inpatient and outpatient psychiatric services of a tertiary care hospital in India. The tools used were: Mini International Neuropsychiatric Interview, Sexual and Physical Abuse History Questionnaire, abuse-related Beliefs Questionnaire, Sexual Abuse Severity Score, Trauma and Attachment Beliefs Scale, Brief Symptom Inventory and Social Adjustment-Self Report.
Results:
About 21% of the sample had a history of CSA; among them 70% were females. The age of CSA ranged between 8 and 12 years. About 34% of them had more than 5 such experiences and about half of them had more than 2 perpetrators with majority of the sample experiencing high coercion. The survivors of CSA had greater levels of psychopathology, trauma and attachment beliefs, difficulties in certain domains of interpersonal functioning in comparison with individuals without a history of CSA. Female gender, poor parental emotional support, and having more than one significant life event contributed to risk of CSA. Poor emotional support from parents and trauma related beliefs predicted psychopathology.
Conclusion:
The study has implications with respect to the assessment, research and conceptualization of therapy in individuals with a history of CSA.
Background:
Maternal mental health has specific implications for bonding and infants’ mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have ...adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants’ development and quality of life (QOL), in case of mothers with severe mental illnesses in remission.
Methods:
The study included 41 mother–infant dyads from the outpatient perinatal psychiatry services and the mother–baby unit of the current study center. Symptom status, self-reported bonding, mother–infant interactions, and infants’ development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively.
Results:
Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants.
Conclusion:
The association between mothers’ bonding and infants’ mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother–infant bonding, development, and quality of life.
Anger is a natural feeling which is essential for survival, however, which can impair functioning if it is excessive. Adolescents need to be equipped with skills to cope with their anger for the ...promotion of their health and safety. This study aims to examine the effectiveness of anger management program on anger level, problem solving skills, communication skills, and adjustment among school-going adolescents.
An experimental, pre-test-post-test control group design with a multistage random sampling was adopted to select 128 school-going adolescents aged between 13 and 16 years. Experimental group received six sessions of anger management program, while control group received one session on anger management skill after the completion of post-assessment for both the groups. Sessions included education on anger, ABC analysis of behavior and relaxation training, modifying anger inducing thoughts, problem solving, and communication skills training. Assessment done after the 2 months of anger management program. Data were analyzed through descriptive and inferential statistics.
Study reveals the improvement in the problem solving skills (81.66 ± 4.81), communication skills (82.40 ± 3.82), adjustment (28.35 ± 3.76), and decreased anger level (56.48 ± 4.97). Within the experimental and between the experimental and control group, post-test mean scores differed significantly (
< 0.05).
The results revealed that the anger management program was effective in decreasing anger level and increasing problem solving skills, communication skills, and adjustment among school-going adolescents.
Identifying the determinants of positive coping is a critical step in empowering the parents of children with intellectual disability. In this context, this study aims to develop a scale to assess ...the determinants of positive coping. Accordingly, culturally relevant items were pooled, got validated by experts and refined. The scale was administered to 150 parents of children with intellectual disability. Factor analysis done through polychoric correlation helped reduce the items. Cronbach’s alpha coefficients were established for reliability testing. The validity of the new scale was examined with the subjective wellbeing on a visual analogue scale and Family Interview for Stress and Coping in Mental Retardation. The new scale has a Cronbach’s alpha of 0.71 and an intraclass correlation of 0.64. After factor analysis, 12 items were retained in the final version. This study also identified specific factors associated with positive coping. The new scale can be used with parents of children with intellectual disabilities to identify the determinants of positive coping.
Background:
The relationship between imprisonment and mental illness is bidirectional. The clinical outcomes of prisoners with mental illness have not been widely studied, especially in developing ...countries. This study was conducted to assess the same among male inpatients under judicial custody with charges of homicide.
Methods:
A retrospective chart review of male forensic ward inpatients admitted between January 1, 2003, and December 31, 2016, was conducted. Diagnosis in the files was based on the International Classification of Diseases (ICD)-10 criteria. The Clinical and Global Improvement—Severity (CGI-S) scale was used to measure the severity of illness. Mean CGI-S assessment was carried out at baseline, end of 1 year, 5 years, and 15 years. The data were analyzed using descriptive statistics, Friedman’s test, and Dunn’s post hoc test.
Results:
Schizophrenia spectrum disorders and other psychotic disorders, mood disorders, and alcohol use disorders were diagnosed in 62(49.6%), 22(17.6%), and 44(35.2%) subjects, respectively. Forty-one (32.8%) subjects had at least one readmission. The average CGI-S score for the total subjects was 5 (markedly ill) at baseline and 2 (borderline ill) at the end of their latest contact with the tertiary care hospital. For the 34 subjects (27.2%) who had follow-up information of 15 years, the average CGI-S score was 1 (normal, not at all ill) at the end of 15 years (P < 0.001).
Conclusion:
Clinical outcomes of prisoners with mental illness seem promising, subject to the seamless availability of services. Studies from other parts of the country are required for a more systematic understanding of the requirements of care.
Background:
Recent life events may be significant risk factors for depression during pregnancy. However, its association with the individual’s resilience and social support is not clear.
Aims:
To ...understand the association between life events and depression during pregnancy and whether the association is moderated by resilience and social support.
Methods:
This study is part of a prospective cohort study on perinatal mental health in an urban antenatal clinic, which included 589 women recruited in the first and early second trimester. Participants were administered the Life Events Checklist adapted from the Social Readjustment Rating Scale by the authors to assess life events; Edinburgh Postnatal Depression Scale (EPDS) and Connor–Davidson Resilience Scale-10 to assess depression and resilience, respectively. The relationship between life events (12 months prior to the time of assessment) and antenatal depression and the moderating role of resilience and social support was analysed.
Results:
Thirty-eight women (6.5%) who had depression (EPDS score ⩾ 11) had significantly higher number of life events (i.e. on average three; U = 3,826; p < .01), lower resilience scores (U = 4,053; p < .01) and lower perceived social support (U = 2,423; p < .01) as compared to those who were negative for depression on EPDS. Life events predicted depression during pregnancy; however, the relationship was moderated by social support but not by resilience.
Conclusion:
The pregnant women who experienced life events may experience depression during the first trimester of pregnancy, but the effect could possibly be reduced by enhancing the social support.
Experiential avoidance (EA) and mindfulness are the two important transdiagnostic process and outcome variables in psychological formulation and treatment. While smartphones have a large utility ...value, they also have the potential for adverse impacts on functioning. Studies have separately shown associations among EA, dispositional mindfulness (DM), and problematic smartphone use (PSU). However, there is a lack of study exploring the associations and mediation relationship among these variables together in an Indian context. The current study aims to explore the associations of PSU, DM, EA, and sociodemographic factors; including the mediating effect of EA between DM and PSU in the Indian adult context.
Four hundred and thirty-four participants (
age = 25.4, standard deviation = 2.6, 58.8% females) were recruited for an online survey using a cross-sectional design. Data were collected using sociodemographic questionnaire, Smartphone Addiction Scale-Short Version, brief EA scale, and Mindfulness Attention Awareness Scale. Statistical analyses comprised multiple regression, mediation analysis, and significance in sociodemographic variables.
Both EA and DM significantly predicted PSU with a 37% variance; however, DM had an inverse relationship. EA as a mediator could account for a quarter of the effect, P
= 24.4%,
= -0.14, 95% CI
(-0.19, -0.09).
The current study implicates the monitoring and treatment planning for PSU from a transdiagnostic perspective in the Indian context.
