Background: Preliminary reports suggest that during the COVID-19 pandemic, telecounseling could be an effective model of psychological intervention for the frontline healthcare workers (fHCW) with psychological problems. Literature is sparse in this area, particularly from low- and middle-income countries, including India. We aimed to investigate the feasibility and the effectiveness of telecounseling (vs. general education) on the psychological problems of the fHCW over three time-points (baseline vs. end-of-session and at two and four weeks after the intervention). Methods: The study followed a single-blind, active arm versus general education, parallel-group randomized control design, with participant allocation in 1:1. Active healthcare workers (HCWs) with mild- to-severe or clinically concerning scores on any of the sub-scales of Depression, Anxiety and Stress Scale (DASS-21) or Impact of Event Scale-Revised (IES-R; represented by higher scores) were included, while those with known psychiatric illness were excluded. Chi-square and Mann-Whitney U test and linear-mixed effect model (group-, time, and group by time-effect) were used for analysis. Results: There were no baseline group differences (telecounseling group, active arm, n = 9; general education group, control arm, n = 10). A significant time-effect (P = 0.044 to <.001) was found on DASS-21 on intention-to-treat analysis. Per-protocol analysis, additionally, found a significant group effect on Impact of Event Scale-Revised (IES-R; P = 0.036). A significant random effect of the participants was also found (P <.001). Conclusion: Telecounseling could be a feasible and scalable model of psychological interventions for the fHCW with psychological problems, albeit with some feasibility challenges.

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Youth suicide is a significant public health problem in Low-and middle-income countries (LMIC), including India. It is a distinct phenomenon with various bio-psycho-social determinants. Despite this, comprehensive literature on this topic is lacking from India. Thus, the current paper aimed to review the available literature on youth-suicide from India and other LMIC, discusses the contentious issues, including potential solutions for the possible roadblocks, and provides recommendations for the national suicide-prevention policy and strategy (NSPPS) in the Indian context. We found that the magnitude of youth suicide in India is substantial with the distinct bio-psycho-social determinants. Although, youth-specific suicide prevention and therapeutic intervention do exist; its feasibility and effectivity in the Indian context are yet to be established. The is an urgent need for the NSPPS; experiences from other LMIC should be incorporated while framing such policies. More research is required from India in this area.

Objective: Literature investigating the change in psychological problems of the healthcare workers (HCWs) throughout the COVID-19 pandemic is lacking. We aimed at comparing the psychological problems and attitudes towards work among them over two waves of the COVID 19 pandemic in India. Methods: A survey was conducted involving HCWs (n=305, first-wave, 2020; n=325, second wave, 2021). Participants’ demographic- and professional- and psychological characteristics (using attitude towards COVID-19 questionnaire [ATCQ]; Depression, Anxiety, and Stress Scale – 21 Items and impact of event scale-22) were recorded. The unpaired ‘t-test/chi-square test was used for comparison. Results: A significant improvement in level of depression (42.2% vs 9.6%), anxiety (41.3% vs 16.3%), stress (30.1% vs 6.7%), event-related stress symptoms (31.2% vs 27%), work-related stress (89.8% vs 76.8%), and stigma (25.9% vs 22.8, though marginally significant) (χ2(1) =7.3 to 45.6, p<0.05) were found among the participants of the second wave (vs. first wave). However, on subgroup analysis, allied-HCWs (housekeeping staff, and security personnel) reported lesser concerns over the domains of the KAQ vis-a-viz frontline-HCWs [doctors and nurses]. Conclusion: This improvement could be attributed to greater awareness about the illness, better coping skills, vaccination, etc, however, more research is warranted to investigate these determinants.

Psychiatric manifestations of pellagra could be subtle but important to recognize in clinical practice. These may vary from non-syndromic symptoms of anxiety, depression, and psychosis to pellagrous encephalopathy. The course and outcome of pellagra’s non-encephalopathic psychiatric manifestations (NEPM) are variable and have not received much attention. Therefore, a review in this regard is deemed necessary to understand the evolution of psychiatric symptoms and possible neurochemical changes produced in pellagra. A focused scoping review of the literature using Preferred Reporting Items for Systematic reviews and Meta-Analyses- extension for Scoping Reviews (PRISMA-ScR) guidelines was carried out to chart the results of studies to find out the characteristic nature of NEPM, role of niacin, and underlying etiopathogenesis. The review included 12 studies comprising 271 participants. Depressive and insomnia symptoms were the most frequent manifestations of NEPM followed by anxiety, thought disorder, psychomotor agitation, hallucinations, confusion, and disorientation. Alcohol use remains the most common cause of NEPM in pellagra, followed by nutritional deficiency. The alteration in the kynurenine pathway is a probable mechanism implicated in the NEPM of pellagra and future research should explore the role of niacin replacement in such patients. The findings of the review incite further discussion and research on biomarkers for patients with pellagra and subtype of patients with depression who share a common immune-inflammatory pathway.

Background Schizophrenia is a life-shortening disease. The standardized mortality ratio has been higher than that of the general population, and it has doubled what it was 3-4 decades ago. This rise is mostly attributed to the increased cardiovascular risk associated with high second-generation antipsychotic (SGA) use. Evidence from the first-generation antipsychotic (FGA) era shows a lower prevalence of hypertension (HTN) but data regarding SGAs is scarce. Purpose The purpose of the study was to assess the prevalence of HTN and related factors using standardized methodology in patients with schizophrenia on treatment with SGAs. Methods A cross-sectional study through convenient sampling was done. Blood pressure, anthropometry, physical activity, and health-related lifestyle factors were assessed using the standard World Health Organization (WHO) methodology of cardiovascular survey methods and the Global Physical Activity Questionnaire (GPAQ) version 2. The prevalence of HTN, obesity, inadequate physical activity, and other demographic and clinical correlates like antipsychotic use, duration of illness, and family history of non-communicable diseases (NCDs) were studied. Results The prevalence of HTN is 20.50%, and it increases with age. SGAs with the use of a single agent are the most common. In total, 45.50% of persons with schizophrenia have a positive family history of a NCD; 22.00% and 07.50% are current tobacco and alcohol users, respectively; and 70% have abdominal obesity, and 54% have generalized obesity. Waist circumference, obesity, and family history of NCDs are significant correlates of HTN. A family history of NCDs is the most significant predictor. Conclusion The prevalence of HTN is lower than that of the general population despite the high prevalence of SGA use, obesity, and inadequate physical activity.