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   Table of Contents - Current issue
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October-December 2021
Volume 5 | Issue 4
Page Nos. 101-162

Online since Tuesday, November 30, 2021

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EDITORIAL  

Psychosomatic diseases and COVID-19 p. 101
Jian-An Wang
DOI:10.4103/hm.hm_70_21  
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ORIGINAL ARTICLES Top

A comparative epidemiology model for understanding mental morbidity and planning health system response to the COVID-19 pandemic p. 103
David Cawthorpe
DOI:10.4103/hm.hm_60_21  
Introduction: This particular coronavirus disease is a pandemic giving rise to great global affliction and uncertainty, even among those who have dedicated their lives to health care or the study of disease, or both. Notwithstanding those directly affected, the lives of all people have been turned upside down. Each person has to cope with her or his personal situation and a story is taking shape for everyone on earth. Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 virus, the source of the 2020 pandemic. This paper contains brief highlights from a duplicable PubMed search of the COVID-19 literature published from January 1 to March 31, 2020, as well as a duplicable search of past influenza-related publications. Excerpts from select papers are highlighted. The main focus of this paper is a descriptive analysis of influenza and other respiratory viruses based on a 16-year population-based dataset. In addition, the paper includes analyses based on the presence or absence of mental disorder (MD) in relation to influenza and all other respiratory viruses. Methods: The investigation is descriptive and exploratory in nature. Employing a case-comparison design, a 16-year population-based dataset was analyzed to both understand the present and plan for the future. While not all viral infections are equal, this paper focuses on system responses by describing the epidemiology of respiratory viruses, such as influenza. Influenza is established in the global population and has caused epidemics in the past. Where possible direct comparisons are made between COVID-19, influenza, and other respiratory viruses. Results: Those with MD had a higher rate of viral infection per 100,000 capita compared to those with the viral infection and no MD. Further, the postviral infection MD rate was not higher compared to the MD per capita rate before viral infection. The postinfluenza rate of MD among those who were without mental disorder before influenza represents an estimate of postinfection mental health burden. Conclusions: In summary, those with preinfluenza MD are at greater risk for viral infection. Further, while the postviral infection MD rate was not higher compared to the MD per capita rate before viral infection, this independent estimate may inform the degree to which services may need to undergo a sustained increase to address the bio psychosocial needs of each served population were COVID-19 to persist and become established in the global population.
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Somatic versus cognitive depressive symptoms as predictors of coronary artery disease among women with suspected ischemia: The women's ischemia syndrome evaluation p. 112
Ashley S Emami, C Noel Bairey Merz, Jo-Ann Eastwood, Carl J Pepine, Eileen M Handberg, Vera Bittner, Puja K Mehta, David S Krantz, Viola Vaccarino, Wafia Eteiba, Carol E Cornell, Thomas Rutledge
DOI:10.4103/hm.hm_34_21  
Background: Depression is an established predictor of coronary artery disease (CAD) progression and mortality. “Somatic” symptoms of depression such as fatigue and sleep impairment overlap with symptoms of CAD and independently predict CAD events. Differentiating between “somatic” and “cognitive” depressive symptoms in at-risk patients may improve our understanding of the relationship between depression and CAD. Methods: The study utilized data from the Women's Ischemia Syndrome Evaluation. Participants (N = 641; mean age = 58.0 [11.4] years) were enrolled to evaluate chest pain or suspected myocardial ischemia. They completed a battery of symptom and psychological questionnaires (including the Beck Depression Inventory [BDI]) at baseline, along with quantitative coronary angiography and other CAD diagnostic procedures. The BDI provided scores for total depression and for cognitive and somatic depressive symptom subscales. Results: Two hundred and fourteen (33.4%) women met criteria for obstructive CAD. Logistic regression models were used to examine relationships between depression symptoms and obstructive CAD. Neither BDI total scores (odds ratio [OR] =1.02, 95% confidence interval [CI], 0.99–1.05, P = 0.053) nor BDI cognitive scores (OR = 1.02, 95% CI, 1.00–1.04, P = 0.15) predicted CAD status. BDI somatic symptom scores, however, significantly predicted CAD status and remained statistically significant after controlling for age, race, and education (OR = 1.06, 95% CI, 1.01–1.12, P = 0.02). Conclusion: Among women with suspected myocardial ischemia, somatic but not cognitive depressive symptoms predicted an increased risk of obstructive CAD determined by coronary angiography. Consistent with prior reports, these results suggest a focus on somatic rather than cognitive depressive symptoms could offer additional diagnostic information.
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Unpredictable chronic mild stress-induced depressive-like behaviors in spontaneously hypertensive rats p. 119
Lijun Zhang, Meiyan Liu
DOI:10.4103/hm.hm_49_21  
Objective: The objective is to explore whether hypertension influences unpredictable chronic mild stress (UCMS)-induced depressive-like behaviors and the potential therapeutic effect of Guan-Xin-Shu-Tong capsules (GXST) in controlling hypertension and depressive-like behaviors. Materials and Methods: Fifteen spontaneously hypertensive rats (SHR) and 15 wistar rats were divided into three groups respectively (n = 5, in each group), including control, UCMS, and UCMS + GXST groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at the end of the experiment. Rats were subjected to seven kinds of UCMS over 4 weeks. GXST treatments were administrated (2.8 g/kg) by intragastric gavage once a day over 4 consecutive weeks during UCMS treatment. Sucrose-preference and open-field tests were used to detect depressive-like behaviors. Results: SHR exposed to 4-week UCMS treatment had lower HR when compared with control and UCMS + GXST groups (P < 0.05); Wister rats receiving UCMS or UCMS + GXST had lower SBP (P < 0.05), lower DBP (P < 0.05) and lower MAP (P < 0.05) than controls. Compared with the controls, UCMS reduced the sucrose preference of Wistar rats, UCMS and UCMS + GXST decreased both grid-crossings and the number of upright postures measured in Wistar rats (P < 0.05). SHR showed lower sucrose consumption, less sucrose preference, and fewer grid-crossings after UCMS than control SHR. However, the lower incidence of upright postures in SHR was prevented by GXST treatment (P < 0.05). Linear correlation showed that grid-crossings or upright postures were negatively related to the values of SBP, DBP, or MAP, presenting the positive relationship between depressive-like behaviors and SBP, DBP, or MAP reduction in Wistar rats; there was a negative correlation between grid-crossings and DBP responses, and MAP responses in SHR, and a positive correlation between depressive-like behaviors and DBP and MAP response elevation in SHR. Conclusions: UCMS-induced depressive-like behaviors in Wistar and SHR, accompanied by a blood pressure decrease in Wistar rats but not in SHR. While GXST exhibited effective relief of depressive-like behaviors in SHR without influencing their blood pressure.
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Patient perspective on telehealth during the COVID-19 pandemic at the cardiology outpatient clinic: Data from a qualitative study p. 132
Mirela Habibovic, Channa M Kraaij, Steffen Pauws, Jos W. M G. Widdershoven
DOI:10.4103/hm.hm_39_21  
Background: Within the field of cardiology, telehealth has been advocated by many as important benefits have been demonstrated regarding disease management and survival. Both patient- and physician-related barriers have hampered the uptake of telehealth in the clinical practice. The COVID-19 pandemic has pushed the upscaling of telehealth modalities. Objective: The current study will examine patients' preferences, needs, and recommendations regarding the use of telehealth at the cardiology outpatient clinic during the pandemic. Methods: Semi-structured focus groups were organized covering two themes: (1) patients' experiences with telehealth and (2) patients' needs and recommendations regarding the use of telehealth. Focus groups were held online using Microsoft Teams, and audio recordings were made. After transcribing the recordings, thematic analysis was applied to code the answers that were given. Results: A total of n = 19 patients were recruited; the mean age was 62.4 (7.7) and 10 (52.6%) were female. The majority of the patients (15/19) indicated to be positive regarding telehealth use mainly due to its time-saving character. Four patients were negative toward telehealth as they did not receive appropriate care in their perception due to telehealth use. Patients recommend using blended care where teleconsultation, and face-to-face appointments are provided in accordance with patients' preferences. Conclusions: This is the first study to examine, in-depth, cardiac patients' experiences, needs, and recommendations regarding telehealth use in the clinical practice. Learning from current experiences with the COVID-19 pandemic where upscaling of telehealth emerged will give us a foundation to further increase the uptake of telehealth in the clinical practice.
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Using a quality improvement project to enhance the standard vaccination rate for long-term patients in mental health services in Qatar p. 138
Nervana Elbakary, Sadaf Riaz, Islam Mahran, Ahmed Hani Assar, Oraib Abdallah, Rania Abukuhail, Noriya AlKhuzaei, Yassin Eltorki
DOI:10.4103/hm.hm_47_21  
Background: Countries launch vaccination programs to ensure vaccination coverage as part of the global health security. Special populations including patients with severe mental illness are under average vaccination rate. We aimed to improve the percentage of long-term patients in Qatar's mental health services who received their routine vaccination by the end of 2020 from a baseline rate of 10% to 90% from all vaccination types needed. Methods: This was an interrupted time series quality improvement project using two structured Plan-Do-Study-Act cycles to test the success of the outcome and process measures to reach the desired aim. Run charts were utilized to display the monthly vaccination rates as an outcome measure and the rate of vaccination refusals by the patients as a process measure. A multidisciplinary team was assembled. Root cause analysis was performed. Prioritizations for certain types of vaccines to be given were done. Results: We identified 50 eligible patients. Throughout 12 months, we reached a final vaccination rate of 92%. Number need to treat was used to express the effect size and was calculated as 1.2. Refusals to vaccinations by patients dropped from 41% at the start of the project to only 4% by the end. Conclusion: High vaccination rates over a 12-month period can serve as an indication for the success of the intervention. Sustainability of the results can be achieved by multiple strategies. These results may be useful to hospitals considering vaccine implementation or those currently struggling with implementation barriers.
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Interpersonal psychotherapy knowledge dissemination in China p. 144
Wanhong Zheng, Xuejun Liu, Dilip N Chandran, Joanna L Twist, Aradhita Yadava, Weihui Li, Mark Miller
DOI:10.4103/hm.hm_52_21  
While many Chinese mental health professionals are familiar with modern psychotherapy, psychoanalysis, and cognitive behavioral therapy (CBT) are the mainstream therapy education and practice in today's China. Interpersonal psychotherapy (IPT) is a time-limited evidence-based psychotherapy that was originally developed for the treatment of depression. It has since been supported by over 250 randomized clinical trials in the treatment of various mental conditions including anxiety, and eating disorders. Despite good evidence for efficacy, IPT was not formally introduced to China until recently. This article describes a strategic plan for disseminating IPT knowledge in China and reports on current progress to date. We also summarize the discussion results from recent training lectures and workshops, and present suggestions for cultural adaptation per feedback from many enthusiastic trainees. Challenges and the future of promoting further integration of IPT as another effective psychotherapy option in China are discussed as well.
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COMMENTARY Top

Interpersonal psychotherapy reaches out p. 153
Myrna M Weissman
DOI:10.4103/hm.hm_54_21  
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Importance and application of interpersonal psychotherapy during the COVID-19 pandemic p. 155
Holly A Swartz
DOI:10.4103/hm.hm_55_21  
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CASE REPORT Top

A case report: Steroid-induced mania in the context of COVID-19: The compounding impact of treatment on mental health p. 157
John Michael Perez, Spencer Murdock, Sarah Singh, Wanhong Zheng
DOI:10.4103/hm.hm_17_21  
The coronavirus disease 19 (COVID-19) pandemic has negatively affected people's day-to-day lives, especially those with mental illness. We present a case of a manic episode with psychotic features induced by dexamethasone administered as part of COVID-19 treatment. The patient had underlying depression, anxiety, and posttraumatic stress disorder, but was stable before contracting COVID-19. The implications of quarantine and social stress on mood stability are also discussed. We call for better patient education on the risks of steroid-induced mania and psychosis as well as increased attention to mental illness screening and treatment during this unprecedented pandemic time.
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LETTER TO THE EDITOR Top

Body and mind: Two maps but one territory. mental coaching in support of somatic correlates in times of COVID-19 p. 161
Giuseppe Marano, Eleonora Gaetani, Gabriele Sani, Marianna Mazza
DOI:10.4103/hm.hm_50_21  
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