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Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients’ clinical status. Representative samples are needed to inform service planning and research.
To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar.
Retrospective review of 50 consecutive referrals.
Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%).
A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.
The catastrophic declines of three species of ‘Critically Endangered’ Gyps vultures in South Asia were caused by unintentional poisoning by the non-steroidal anti-inflammatory drug (NSAID) diclofenac. Despite a ban on its veterinary use in 2006 (India, Nepal, Pakistan) and 2010 (Bangladesh), residues of diclofenac have continued to be found in cattle carcasses and in dead wild vultures. Another NSAID, meloxicam, has been shown to be safe to vultures. From 2012 to 2018, we undertook covert surveys of pharmacies in India, Nepal and Bangladesh to investigate the availability and prevalence of NSAIDs for the treatment of livestock. The purpose of the study was to establish whether diclofenac continued to be sold for veterinary use, whether the availability of meloxicam had increased and to determine which other veterinary NSAIDs were available. The availability of diclofenac declined in all three countries, virtually disappearing from pharmacies in Nepal and Bangladesh, highlighting the advances made in these two countries to reduce this threat to vultures. In India, diclofenac still accounted for 10–46% of all NSAIDs offered for sale for livestock treatment in 2017, suggesting weak enforcement of existing regulations and a continued high risk to vultures. Availability of meloxicam increased in all countries and was the most common veterinary NSAID in Nepal (89.9% in 2017). Although the most widely available NSAID in India in 2017, meloxicam accounted for only 32% of products offered for sale. In Bangladesh, meloxicam was less commonly available than the vulture-toxic NSAID ketoprofen (28% and 66%, respectively, in 2018), despite the partial government ban on ketoprofen in 2016. Eleven different NSAIDs were recorded, several of which are known or suspected to be toxic to vultures. Conservation priorities should include awareness raising, stricter implementation of current bans, bans on other vulture-toxic veterinary NSAIDs, especially aceclofenac and nimesulide, and safety-testing of other NSAIDs on Gyps vultures to identify safe and toxic drugs.
We report an approach to expand the effective number of pixels available to small, two-dimensional electron detectors. To do so, we acquire subsections of a diffraction pattern that are then accurately stitched together in post-processing. Using an electron microscopy pixel array detector (EMPAD) that has only 128 × 128 pixels, we show that the field of view can be expanded while achieving high reciprocal-space sampling. Further, we highlight the need to properly account for the detector position (rotation) and the non-orthonormal diffraction shift axes to achieve an accurate reconstruction. Applying the method, we provide examples of spot and convergent beam diffraction patterns acquired with a pixelated detector.
The catostylid jellyfish, Crambionella annandalei was originally described by Rao (1932) based on a preserved specimen collected from the Andaman Sea. Since then, no detailed taxonomic studies have been conducted and the species is often misidentified. Here, we provide a detailed morphological re-description of C. annandalei from fresh material collected at a variety of locations along the east coast of India. The species can be distinguished from its congeners by a combination of morphological characters, the most important of which are the proportion of terminal club length to oral arm length (0.48 ± 0.031), the proportion of the distal portion of the oral arm to naked proximal portion (7.25 ± 0.268) and the body colour. The occurrence of intra-specific colour variation in fresh specimens was also observed in the present study.
Knowledge of bio-physicochemical variables is essential to better understand the functioning of tropical marine ecosystems, which are rich in biodiversity and provide nutrition and livelihoods to billions of people in the developing countries. This study analysed the spatial and temporal variability of phytoplankton and zooplankton with chlorophyll, primary productivity, temperature, salinity, oxygen and nutrients in the Bay of Bengal (BoB), collecting data from the World Ocean, and COPEPOD and Aqua MODIS records. The results indicated a strong gradient in bio-physicochemical conditions of the BoB, from the coast to the open sea. Specifically, the spatial variability in chlorophyll was negatively correlated (R2 = 0.59) with temperature and zooplankton, while a positive correlation (R2 = 0.70) was noted between chlorophyll and silicate, nitrate, phosphate, dissolved oxygen and salinity. All the variables exhibited a strong vertical gradient at depths up to 500 m. Temperature, nutrients, zooplankton and to a lesser extent salinity and rainfall had an influence on the annual abundance of phytoplankton. Over the long term, a significant positive trend in temperature and a significant negative trend in primary productivity were observed in the BoB. The findings of this study will be useful to draw insights on the state of fisheries habitats and the overall environmental conditions of the BoB in response to future climate changes.
In this work, the authors developed SiC(10 nm)/Ag/SiC(10 nm) thin films showing an electroforming-free resistive switching (RS) effect with a switching ratio of 102. The observed RS effect is attributed to charging and discharging of Ag nanoparticles in the film layer. Further, SiC/Ag/SiC film shows an excellent endurance and retention as well as a good thermal stability of RS characteristics. It is also identified that the switching ratio is invariant but the switching voltage of the device greatly depends on the Ag nanoparticles concentration and the operation temperature of the device. Therefore, SiC/Ag/SiC thin films are attractive for next-generation memory devices with enhanced durability.
Conventional planar manipulators have their links in a single plane. Increasing payload at the end effector/mobile platform can induce high stress in the links due to the cantilever nature of links. Thus, it limits the total vertical load that can be applied on the mobile platform. In contrast to the links in conventional planar parallel mechanisms, non-planar links are proposed in this paper, that is, links are made inclined to the horizontal plane and non-planar legs are constructed. Though the links are made non-planar, the end effectors’ planar motion is retained. For studying the application of such non-planar links in planar manipulators, new models of inertia, stiffness and leg dynamics have to be developed. In this article, these models are developed by the static analysis of the planar manipulators with non-planar links, and the performance is compared with the corresponding conventional planar manipulators.
In this study, AA5083-reinforced multiwalled carbon nanotubes (MWCNT) nanocomposites were selected as the alternate material for a redundant articulated robot (RAR) design by varying the composition of MWCNT wt%. By assigning AA5083-reinforced MWCNT as a custom material to the parts of RAR developed by Solid Works and exported to MATLAB/SimMechanics platform to convert the model into multi-body system blocks. The dynamic parameter torque was observed utilising simulation capability in a SimMechanics second-generation environment. The simulation results inferred that AA5083 reinforced with increased wt% of MWCNT has better properties suitable for RAR design.
Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
The prevalence of substance use among pregnant women varies widely. The reported prevalence varies between 0.2 and 15% for alcohol, between 1.8% and 15% for cannabis, and between 0.3% and 9.5% for cocaine. The reported prevalence of opiate use during pregnancy ranges from 1.6% to 8.5%. The prevalence varies widely because of differences in the methods of assessment, gestational period of assessment and population characteristics. There is clear evidence that substance use in this population is an issue of real and serious concern. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment.
We report the prevalence of smoking, drinking and illicit substance use among 420 women attending for 20 week antenatal ultrasound scan in a UK University Hospital is reported. Routine antenatal recording of substance use among this population is compared with a focused interview and objective measurements for substance use. Change in use of substances in relation to pregnancy is also reported.
Though a number of agents are available to treat acute manic episode but either because of their comparable efficacy to lithium or their dose related side effects, need for better agent is always being felt.
To study the efficacy and side effect profile of lamotrigine and its double blind comparison with lithium in acute mania.
We recruited 50 patients with diagnosis of manic episode according to DSM-IV and were divided into two groups. One group was given lamotrigine 100mg and another lithium 900mg in a double blind fashion. Patints were assessed subsequently on BPRS, CMRS,UKU side effect scale and CGI till next 28 days.
Subjects in lamotrigine group did not show much improvement at the end of 4th week as compared to lithium group. Side effect profile of both groups were in accordance with reported literature except that 61.9% patients in lamotrigine group showed weight loss. Also rash were found in only 3.5% of the lamotrigine group even with such a rapid escalation of the dose.
We found that lamotrigine is ineffective in case of acute manic episode when compared with lithium.
An understanding of the epidemiology of alcohol and drug use in young women is important to appreciate the considerable morbidity and mortality associated with it and to understand the impact of such use on offspring. Although abstention rates are consistently higher among women than men in general substance misuse is increasing in young women. Differences in definitions, measurement techniques, availability, social acceptability and affordability partly explain the great variability in reported prevalence rates. Alcohol exposure among pregnant women varies from 0.2% to 14.8%. An Australian national survey revealed that nearly half of pregnant and / or breast-feeding women up to 6 months postpartum were using alcohol. A Swedish study reported risky use of alcohol during the first 6 weeks of pregnancy, at 15%. Cannabis use among pregnant women varies from 1.8% to 15%. The reported prevalence of opiate use during pregnancy ranges from 1.65% to 8.5%. Cocaine use among pregnant women is reported to be between 0.3% and 9.5%. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment. Substance use tends to increase sharply in the postpartum period with adverse consequences for mother and baby. Perinatal substance misuse interventions can reduce adverse neonatal outcomes. On the basis of the relatively high rate of substance use disorders during pregnancy and postpartum period, effective screening and intervention strategies should be implemented.
Prevalence: Substance use in young women (16-24 years old) has increased in the last decade. Twenty-four per cent of young women aged 16-24 are 'heavy drinkers' (defined as more 6 units in a day on at least one day in the previous week). Several studies conducted in the UK in the 1990s on different populations of pregnant women demonstrated nicotine use in about a third of pregnant women, cannabis use in about 11%, opiate use in less than 2% and cocaine use is about 1%. Other studies confirmed that 10.6-15.6% of antenatal women will be using substances other than tobacco in the first trimester and when objective measures on women in labour were reported about 3.5% had evidence of substances other than tobacco. Consequences: It is estimated that at least a quarter of a million children are growing up in homes where one or both parents have drug problems which may expose them to social and environmental hazards in the UK. The National Confidential Enquiry into Maternal Deaths found that the overall leading cause of pregnancy related death is psychiatric disorder, and 8% of all mothers who died were substance users especially young disadvantaged women who were up to 20 times more likely to die than those from advantaged groups. Impact on the fetus: Studies on the impact of substance misuse on the fetal growth remains relatively under-researched. Smoking in pregnancy is associated with low birth weight, shorter length and increased perinatal mortality. Apart from fetal alcohol syndrome, a major cause of preventable learning disability. Some studies report that cannabis using mothers are some likely to have preterm delivery, minor physical abnormalities, reduced birth length and weight; cocaine use is associated with placental abruption while heroin use is associated with reduced birth weight. There is very little recent research on this topic in the UK. Screening and assessment tools: The variation in reported prevalence is related to different methods of assessment from self report to meconium analysis. Few studies have used objective measures or structured interviews. Studies were also undertaken at different gestational stages in different settings. Substance use in women is underdetected in maternity units and recent robust information on prevalence is not available. In light of the above, this presentation will present a prevalence survey undertaken to establish the nature and extent of substance misuse in pregnant women presenting for scans at 20 weeks gestation.
Previously, we reported the clinical efficacy of MPH-LA in adult ADHD evaluated in a 40-week, randomised, double-blind, placebo-controlled, multicentre core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6- month)] (Atten Defic Hyperact Disord. 2013;(5):219–220). Here, we report the long-term efficacy from the 26-week extension phase of the same study.
During the extension phase, patients initiated treatment with MPH-LA 20 mg/day (oral, once daily capsules); uptitrated to optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Change in DSM-IV ADHD rating scale (RS) and SDS total scores at the end of study, were evaluated from the baseline of maintenance of effect phase of the core study and the baseline of extension phase.
At the end of the extension phase, the mean change in DSM-IV ADHD RS and SDS total scores from baseline of the maintenance of effect phase was −0.9 and −1.4 points respectively; and from baseline of extension phase was −7.2 and −4.8 respectively (Table). No new or unexpected safety concerns were observed during the extension phase.
MPH-LA continued to maintain clinical efficacy in adult ADHD patients over long-term.
Table DSM-IV ADHD RS, SDS total scores and change from baseline at the end of extension phase
Asylum seekers and refugees experience psychological distress at various phases, such as during pre-migration, migration and post-migration. In the post-migration phase, the period of asylum process has many risk factors for severe mental health implications.
The aim of this study was to identify research evidence that suggest asylum process as a cause of psychological distress among the forced migrants in the United Kingdom (UK).
The study was carried out by searching the NHS database for the relevant information and interviewing asylum seekers and refugees.
The literature search identified several relevant studies in this area. However, only one study was found as the most relevant for my study focus. The study was ‘Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland’ by Ryan et al. The qualitative data gathered from the interviews of forced migrants showed a strong link between the asylum process and mental distress.
This research strongly suggests that the asylum process does contain many risk factors causing psychological distress among the asylum seekers. In particular, the restrictions from freedom to work or study, and the constant fear of deportation are the key stressors identified. Increasing the mental health awareness of all personal who come into contact with forced migrants could prevent severe psychological consequences. These points should be taken into consideration for improving the asylum policy and training medical and non-medical staff who may encounter forced migrants.
Schizophrenia is a mental disorder characterized by social problems and disorders of thought, behaviour and cognitive functions. These impaired cognitive functions may be associated with alterations in resting state functional connectivity in schizophrenia. Therefore, the present study has been carried out to determine the resting state functional brain connectivity changes associated with schizophrenia in all the resting state networks (RSNs) using independent component analysis approach (ICA) and dual-regression based approach.
The objective of this study was to investigate the aberrant resting-state functional connectivity patterns in schizophrenia patients as compared to healthy controls.
35 schizophrenia patients and 31 healthy controls were recruited for the study and scanned by using resting state functional magnetic resonance (rsfMRI). Pre-processing and post-processing of the resting state functional data were performed using the FMRI Expert Analysis Tool (FEAT), which is a part of FSL (FMRIB's Software Library, www.fmrib. ox.ac.uk/fsl).
Our results showed significantly decreased functional connectivity in the regions of left fronto-parietal network, lateral visual network, medial visual network, motor network and default mode network (DMN) in schizophrenia patients as compared with healthy controls.
The overall findings suggest that the alterations in these resting state network connectivity may, in part, contribute to the impairments in cognitive functions associated with schizophrenia. These findings also suggest that aberrant resting state network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.
Recent epidemiology studies have reported the prevalence of adult ADHD to be approximately 4%, however approved treatments are limited.
Primary objectives were to confirm the clinically-effective and safe dosage range of MPH-LA in adults with ADHD and evaluate the 6-month maintenance of effect.
Treatment Period (TP) 1: Patients were randomized to double-blind placebo, MPH-LA 40, 60, or 80 mg/day for 9- weeks (3-week titration, 6-week fixed-dose) to evaluate change in DSM-IV ADHD-RS and Sheehan Disability Scale (SDS) total score in TP1. TP2: 5-week titration to individual optimal dose. TP3: Patients were randomized to their optimal dose or placebo for 6-months double-blind withdrawal period to evaluate percentage of treatment failures during TP3.
Improvement from baseline in total score on the DSM-IV ADHD-RS and SDS was significantly greater than placebo for all MPH-LA dose levels (table). Patients treated with MPH-LA had significantly lower treatment failure rates (21.34%) compared to placebo in TP3 (49.6%; odds-ratio (95%CI=0.3 (0.2, 0.4); p< 0.0001). The safety results were consistent with the established safety profile for MPH-LA.
[Improvement by week 9: DSM-IV ADHD-RS and SDS].
N=Full Analysis Set for TP1 (All randomized patients receiving one dose of study drug in TP1)
MPH-LA administered at 40-80mg/day demonstrated superior ADHD symptom control and reduction in functional impairment compared to placebo and demonstrated maintenance of effect over 6 months. No unexpected adverse events were observed.
Mental Illness is a very unique and intimate experience. Over the ages various art forms, particularly writing have been used to document experiences of mental illness. Though the history of Psychiatry is a feature of mainstream Psychiatric training, complementary study of literature and its relevance to mental illness is underused.
To undertake an exploratory search of writing as tool to reflect the phenomenology of mental illness and to evaluate the role of medical humanities in understanding and coping mental illness.
To present an explorative review of a selection of poems and prose by authors with mental illness who have written in English Language.
We conducted a comprehensive search of online databases including the Madness and Literature Network (UK), Medical Humanities Resource Database (UK), the Arts Literature and Medicine Database (US) and other popular books.
We compare various extracts by well known authors along with the lesser known contemporary accounts of writers to evaluate the role of writing.
There is a long tradition of writing about depression mental illness in the canon of English literature. Compared to autobiographical writing about depression, it is difficult to identify many autobiographical accounts of severe mental illness. Examples of writing projects illustrate that people with severe mental illness, and with dementia, may use the support of others to produce creative writing. It may be useful to Psychiatrists in training, and to wider society, to reflect on the creative agency inherent in their writing.
In the UK, blood investigations ordered by the Mental Health Trust are usually carried out by Acute hospitals. The results are not immediately accessible by the staff of Mental Health Trusts on the computer due to confidentiality and lack of shared software access between trusts. This has a significant impact on care management of psychiatric patients often resulting in delay in clinical decisions.
We encountered similar problem where the results of the tests ordered by the staff were not immediately accessible to them, as these investigations are carried out by the local acute hospital. To address this issue a project was chartered.
Of the project was to develop a protocol between the trusts so that the staff of Mental Health Trust could access the results of investigation on local computers as soon as they become available and to evaluate its impact on service.
A steering committee including Specialty Registrar, Pharmacist and Matron was constituted. The committee met regularly and evolved strategy with representatives of the Acute Trust. The main concern of the Acute Trust was patient confidentiality and software access. Following regular meetings and correspondence shared-protocol was developed.
It was agreed that the acute trust would install the software on all mental health trust computers. The staff would be trained to use the software and access results. To address the issue of confidentiality, flowchart of sponsorships of the shared-protocol was developed. Accordingly, all the medics would be sponsored for access by Medical Director, Nursing Staff by Matron and Pharmacists by Chief Pharmacist. This protocol ensured that all the staff trained are accounted and IT department could monitor any unauthorised access of data.
We have noticed a big improvement in the quality of clinical practice as a result. Unnecessary delays in clinical decisions have been avoided. We feel such a shared-protocol could be developed in other hospitals that are faced with similar access issues.
Exhaustive literature is available in the portrayal of mental illness in the English language films. However no major studies are available around the portrayal of mental health in Bollywood movies which in fact is consumed by nearly 25-30% of the world population.
in the era of unprecedented growth in visual medium, we wish to study the portrayal of mental illness in Bollywood cinema and how effective this medium is to create awareness around mental health and stigma.
Literature search with a specific purpose to identify any available literature on mental illness in South Asian cinema was undertaken. to create a synthesis of portrayal of mental illness, its impact on cultural consumption with its advantages and deficiencies. This was followed by a listing a cluster reviews of Bollywood films that have characters with mental health problems to identify how these illustrate both the condition and reactions to them.
These findings were compared with the literature surrounding mental health and the Indian culture to show if the perceptions correlate. The information was collated to see any patterns and 6 such patterns were identified.
Recognising these motifs are crucial for public and clinician alike in contact with the population open to the influence of these films to not only understand the phenomenology of mental illness in this populace but also some of unique cultural factors, medication, stigma and charting out appropriate management plan. (On-going)
The details of the synthetic factors will be presented in the results and discussion.