Chronic obstructive pulmonary disease (COPD) is a lung condition characterized by progressive, partially reversible, preventable, and treatable breathing difficulties that typically worsen over time. Acute exacerbations and frequent comorbidities further contribute to the overall severity of the disease, making everyday activities such as walking or dressing challenging. Psychiatric disorders are increasingly prevalent among individuals with chronic illnesses like COPD. However, despite this trend, psychiatric comorbidities among COPD patients have been less extensively studied compared with general medical conditions. Aim: To study the pattern and prevalence of psychiatric comorbidities among patients with COPD. Materials and methods: This was a cross-sectional, case-control study conducted in a tertiary care hospital after ethical committee approval. A total of 150 diagnosed COPD patients and matched controls were involved after taking their consent. Psychiatric comorbidities screening was done using MINI-7 tool and diagnosis was done using DSM-5. Data were entered in excel and tabulated in SPSS app. Results: We found higher prevalence of psychiatric disorders between the patient group and the control group with a significant p-value (<0.01) and with an odds ratio of 4.1. Major depressive disorder (MDD) was present in 38% of study population. Conclusion: Significant psychiatric comorbidities were present in COPD patients compared with controls. Timely intervention of psychiatric measures will improve the overall burden of COPD patients.

Background: Alcohol is a commonly consumed substance that induces intoxication and can lead to dependence. Alcoholism is often referred to as a family disease due to its harmful impact on the lives of family members and its maximum impact is felt on spouses. Understanding the pivotal role spouses plays in alcohol treatment, there is thus a need to study domestic violence, marital satisfaction, and psychiatric morbidity in spouses of alcohol-dependent patients to understand and address such issues. Aims: This study aimed to assess domestic violence, marital satisfaction, and psychiatric morbidity in spouses of men with alcohol dependence syndrome and explore the association. Materials and methods: A total of 105 spouses of men with alcohol dependence syndrome were evaluated. Severity of alcohol dependence was assessed using severity of alcohol dependence questionnaire (SADQ), marital satisfaction in spouses was assessed using the MAT, domestic violence was assessed using domestic violence questionnaire, mini-international neuropsychiatric interview (MINI) was used to screen for the possible presence of psychiatric morbidity among spouses. Depression and anxiety severity was assessed using Hamilton Rating Scale for Depression (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Results: Out of 105 cases, we found that the mean age of spouse was 22.29. Majority of patients had severe alcohol dependence (46.7%) based on SADQ score. Severe level of domestic violence was present in (28.6%) of spouses. Most of the spouses (50.5%) had a lower level of marital satisfaction and (82.86%) spouses had a psychiatric disorder. Primarily depression and anxiety disorder were present. Domestic violence, marital dissatisfaction, and severity of depression and anxiety in spouses were significantly associated with alcohol dependence. Conclusion: Spouses of alcoholic husbands suffer from high levels of domestic violence, with marital satisfaction being low and psychiatric morbidity in spouses of alcohol-dependent men are high. Addressing these issues will be beneficial as spouses are known to play an important role in the treatment of alcohol dependence syndrome.

Background and aim: Although monotherapy of anti-anxiety drugs is effective in controlling anxiety, due to the progressive nature of the disease, it is often associated with a lack of effectiveness over time. So, this study was carried out to assess the efficacy, safety, and tolerability of clonazepam 0.25 mg and propranolol 10/20 mg fixed-dose combination among anxiety disorder patients. Materials and methods: This was a randomized, double-blind, multicenter, actively-controlled, phase IV study conducted among individuals having established diagnosis of anxiety, total Hamilton Rating Scale for Anxiety (HAM-A) score ≥17, Clinical Global Impressions Severity (CGI-S) score >4 in the week prior to inclusion. The study participants were randomized to receive either the test or the reference drug once daily for 8 weeks. At the last study visit, the degree of a patient's anxiety was assessed by using the HAM-A and CGI-S scores. Results: At week 8, it was observed that there was a decrease in HAM-A score in all the groups. Between the group analysis, at visit 3, there was a reduction in the HAM-A score compared with the randomization visit. The investigator-rated scale and patient-rated global improvement were highest in group B followed by group C compared with group A. Also, there was a notable reduction in group A at week 8 in the CGI-S score as compared with baseline in group B. Conclusion: The combination of clonazepam and propranolol was effective, safe, and well-tolerated. Hence, it can be a significant armamentarium in anxiety disorder management. Clinical significance: The clonazepam 0.25 mg and propranolol 10/20 mg fixed-dose combination showed a significant decrease in the HAM-A score across patients with anxiety disorders and was found to be clinically effective, safe, and well-tolerated.

Aim and background: To draw a comparison between the prevalence of suicidality in patients of obsessive–compulsive disorder (OCD) with depression and without depression. Materials and methods: Ninety patients who visited the psychiatry OPD and were identified as having OCD, as determined by a psychiatrist using the ICD-10 diagnostic criteria, were included in the study. The patients were then screened for depression using the PHQ-9 scale, OCD severity using the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), severity of depression using the Hamilton Depression Rating Scale (HAM-D), and suicide severity using the Columbia-Suicide Severity Rating Scale (C-SSRS). Results: Among the 90 patients, 50 (55.6%) were female, 59 (65.6%) were Muslim by religion, 34 (37.8%) were between the ages of 31 and 40, 25 (27.7%) had severe-to-very-severe depression, and 22 (24.4%) of them had suicidal ideation with 25 patients (27.8%) having a past history of suicidal behavior/attempt. Conclusion: A significant association between suicidality and depression in OCD patients was found with the incidence of suicidal behavior being higher among severe OCD cases (83.3%). Clinical significance: More the severity of OCD, the greater is the plausibility of having depression, anxiety, and other comorbidities. Additionally, the chronic and refractory nature of OCD symptoms can contribute to increased levels of stress and impairment in daily functioning, leading to further negative emotional states and a greater risk of developing depression.

Background: Cognitive impairments, especially executive dysfunction are found to be impaired in patients with depression. Homocysteine is widely implicated in the pathophysiology of a variety of psychiatric disorders because it has a crucial role in cognitive functioning. The level of homocysteine in healthy, elderly individuals is being acknowledged as a risk factor for age-related cognitive impairments and dementia. Therefore, further research is required to understand its role in cognitive impairment, including executive dysfunction, common in depression. Aim: To estimate the level of serum homocysteine in drug naïve patients of depression and determine the correlation with executive functions in the patients. Materials and methods: This is a cross-sectional study done on 50 drug naïve patients diagnosed with depression as per the International Classification of Diseases, 10th revision (ICD-10) criteria. The patients were assessed using the sociodemographic and clinical proforma and their anthropometric measurements (height and weight) were taken. Assessment of the severity of depression was done using the 17-item Hamilton Depression Rating Scale (HAM-D). Stroop test was used to assess executive functioning. Blood samples were collected to assess serum homocysteine levels. The correlation between serum homocysteine levels and executive functioning was determined using appropriate statistical methods. Results: The correlation between serum homocysteine levels and executive function in the study participants was found to be statistically insignificant. Conclusion: The correlation between serum homocysteine levels and executive functioning in drug naïve patients of depression was not found to be significant. Hence, the role of homocysteine as a predictor and therapeutic target for the impairment in executive functioning in patients of depression remains yet unclear. Clinical significance: Knowledge about the biological basis of executive dysfunction in depression may aid in the development of newer strategies for treatment as well as for monitoring treatment response.

Aim and background: Thrombocytopenia is a condition characterized by a decrease in platelet counts less than 1,50,000/µL. Multiple studies have elicited the effect of alcohol on various blood parameters but its effect on platelets is often overlooked. We intend to estimate the prevalence of thrombocytopenia in alcohol dependence syndrome (ADS), to compare the platelet count at baseline with that of the 7th day of admission, to evaluate the association between platelet count with the severity of ADS, and co-morbidities in patients with ADS. Materials and methods: This is an observational study conducted in a tertiary care Medical College Hospital. We recruited 64 inpatients qualifying for ADS whose last intake of alcohol was within five days before admission. Severity of alcohol dependence questionnaire (SADQ) and Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale were administered, platelet count along with CBC was assessed during baseline, and only platelet count was assessed on the 7th day of admission. Statistical analysis paired sample t-test, ANOVA, Pearson's correlation were used. Results: The prevalence of thrombocytopenia at baseline was 18.8% which dropped to 9.4% on day 7 of admission following abstinence from alcohol. At baseline patients with liver disease had significantly lower platelet count than those without liver disease (Mean: 1,93,900/µL vs 2,40,500/µL, p: 0.031) but no statistically significant difference on 7th day (p: 0.8). Baseline platelet count showed negative correlation with age, duration of alcohol use. Conclusion: The prevalence of thrombocytopenia is high in patients with ADS. Clinical significance: Abstinence from alcohol can lead to normalization of platelet count even in patients with co-morbid liver disease.

Aim: To explore the efficacy of adjunctive use of repetitive transcranial magnetic stimulation (rTMS) in patients with schizophrenia with prominent negative symptoms. Materials and methods: It was a hospital-based, prospective, randomized, double-blind, sham-(placebo) controlled, interventional, two-armed trial, including 50 patients with predominant negative symptoms of schizophrenia who were divided into two groups of true and sham rTMS after TMS adult safety screening (TASS) screening and baseline Calgary Depression Scale for schizophrenia (CDSS), schedule for deficit syndrome (SDS), and scale for the assessment of negative symptoms (SANS) recording and weekly SDS and SANS application up till 4 weeks. Results: There was greater reduction of negative symptoms in both SANS (9.04%) and SDS (9.75%) scales in true group as compared with sham group, where SANS and SDS scores were reduced by 1.32% and 0.48%, respectively. Conclusion: The study is part of an emerging area of interest in the field of noninvasive techniques of brain stimulation, and the results are strongly persuading. Clinical significance: This study suggests that the 10-Hz rTMS protocol is an efficacious, adjunctive, noninvasive, interventional strategy for treatment of negative symptoms of schizophrenia.

Background: Depression poses a pervasive challenge to individuals’ well-being, prompting the exploration of alternative therapies due to the limited efficacy of traditional treatments. Recent research has investigated the potential therapeutic role of probiotics, including probiotic nutraceuticals and the probiotic food curd, in addressing mental health concerns. Materials and methods: This 28-day prospective observational study aimed to assess the impact of probiotic interventions on the quality of life in individuals aged 18–60 diagnosed with mild to moderate depression according to ICD-10 criteria. Ninety participants were divided into three groups: One group received probiotic nutraceuticals along with escitalopram, another group received probiotic food (curd) along with escitalopram, and the third group was treated with escitalopram alone. The World Health Organization (WHO) quality of life (WHOQOL-BREF) scale measured participants’ quality of life at the study's initiation and conclusion. Data analysis utilized comparative and statistical methods to evaluate the intervention's impact. Results: Significant improvements in quality of life were observed in individuals with depression after 28 days of treatment. The probiotic group exhibited the most substantial increase in WHOQOL-BREF scores, rising significantly from an initial mean of 34.73 ± 1.55 on day 0 to 46.72 ± 2.47 on day 28 (p < 0.001). In comparison, the escitalopram group showed an increase from 34.58 ± 1.82 to 42.37 ± 2.54 (p < 0.001), and the curd group improved from 35.28 ± 1.35 to 44.43 ± 2.36 (p < 0.001). Conclusion: This study highlights the potential of probiotics as valuable adjuncts to traditional treatments for major depressive disorder (MDD). The findings emphasize holistic approaches to mental health management, opening new avenues for improving the lives of individuals grappling with depression. Despite limitations, this research encourages further exploration and applications of probiotics in mental health care.

The effect of antipsychotics on electron-conduction abnormalities in already diagnosed Wolff-Parkinson-White (WPW) syndrome is under-evaluated which creates a dilemma among practitioners in choosing an effective antipsychotic with minimal side effects. Paliperidone, a second-generation antipsychotic, is Food and Drug Administration (FDA) approved for treating schizophrenia, but the studies have documented mixed results on its effect on QT prolongation. Hence, we are going to present a case of paranoid schizophrenia with comorbid WPW syndrome showing a remarkable response on long-acting paliperidone palmitate depot with no effect on QT prolongation, even after a 2-month follow-up of electrocardiogram (ECG) report.

The childhood gratification disorders are a group of nonpathological, repetitive, pleasure-seeking, self-stimulatory behaviors in early childhood. Due to its varied clinical presentation, it often creates diagnostic dilemma and leads to unnecessary investigations. These behaviors may impact social, cognitive, and emotional growth in children. In developing countries like India, behavioral therapy is difficult to deliver to every patient due to less manpower, less resources, and lack of psychological mindedness in parents. Hence, we need to explore pharmacological interventions. In this regard, it is the first case series comprising three cases of childhood gratification disorder, showing dramatic responses with sodium valproate within a month, and no side effects noted in a long-term follow-up of 3 months duration.