Geriatric mental health: Recent trends in molecular neuroscience

Study of Dhat Syndrome in Men in West Bengal: A Clinic-Based Study

Background:

Dhat syndrome is a culture-bound syndrome of the Indian subcontinent. Traditional and cultural teachings through generations, and myths and misconceptions about sex are its principal contributing factors. Although prevalent, there is scarcity in studies on Dhat syndrome, particularly from Bengal.

Aims and objectives:

1. To study the phenomenology of Dhat syndrome in men attending the out patients department (OPD). 2. To study the comorbid sexual and psychiatric disorders associated with Dhat syndrome.

Methodology:

This was a cross-sectional observational study conducted in the psychiatric OPD in a tertiary care medical college hospital in West Bengal. The duration of the study was 18 months. 122 patients were included in this study that fulfilled the inclusion and exclusion criteria. The diagnosis of Dhat syndrome was made as per International Classification of Diseases, Tenth Revision, diagnostic criteria for research (DCR) criteria. A semi-structured pro forma was used to obtain sociodemographic variables along with numerous physical and sexual symptoms. Mini International Neuropsychiatric Interview was applied for psychiatric comorbidities. Data were analyzed using Statistical Package for Social Studies 17 by SPSS Inc., Chicago.

Results:

122 patients met the inclusion and exclusion criteria. Majority of patients were among age group of 20 to 30 years (60.7%). 56.6% were from the Muslim community and 43.4% were from the Hindu community. 54.1% population was unmarried and 39.3% were newly married. Routes of passage were night falls in 62.3% patients, and 52.5% patients pointed toward passage through urine. Many patients reported passage of semen more than one route. All patients (100%) complained about generalized weakness and thinning of semen. 66.4% had generalized body ache, 55.7% complain about headache, 60.7% decreased body glow, 50% had loss of appetite, 98.4% had decreased self-confidence, sleep disturbance was reported in 34.3% patients, 58.2% reported that their penis was becoming smaller, and 49.2% patients reported decreased sexual capability. The most common comorbid condition was sexual dysfunction (39.3%) followed by depressive disorders (27.9%). Premature ejaculation was found in 54.17% patients and erectile dysfunction in 33.33%.

Conclusion:

Dhat syndrome is a common culture-bound syndrome in Bengal. It is widespread in the Muslim community also. The importance of exploration of sexual comorbidities in Dhat syndrome is very much needed.

Has the COVID-19 pandemic affected the susceptibility to cyberbullying in India?

Owing to the COVID-19 induced lockdown in India, most people’s internet activity surged, leading to an expected increase in the rate of cybercrimes. This research focuses on analyzing whether the factors significant in cyberbullying susceptibility changed with the lockdown. The study was conducted by surveying 256 students before the pandemic, in October 2019, and 118 students during the lockdown, in June 2020. This included questions about the respondents’ demographics, online presence, experience with offline bullying, perception of other’s opinions, and the instances of cyberbullying that apply to them. The results showed factors important in both timespans, namely (i) experience with offline bullying; (ii) individuals’ perceptiveness to others’ opinions; (iii) frequency of social media posts. Additionally, in the period before lockdown, factors namely (i) tendency to interact with strangers online; (ii) whether they’ve started a relationship online (iii) hours spent on social media; were found significant. Conversely, during the lockdown, additional distinct factors namely (i) being opinionated on public platforms; (ii) preference of Instagram; (iii) preferred gaming platform; (iv) number of games played; (v) sexual orientation; (vi) age were significant. With the change in variables in the two timespans, we can conclude that the pandemic has affected our susceptibility to cyberbullying.

Molecular diagnostics of disorders of sexual development: an Indian survey and systems biology perspective

We aimed to survey the monogenic causes of disorders of sex development (DSD) and thereby its prevalence in India. This study revealed mutations resulting in androgen insensitivity syndrome, 5α-reductase type 2 deficiency, and gonadal dysgenesis were commonly reported. Intriguingly, AR deficits were the most prevalent (32 mutations) and of 11/26 missense mutations were in exons 4-8 (encoding ligand binding domain). The unique features of SRD5A2 defects were p.R246Q (most prevalent) and p.G196S could be mutational hotspots, dual gene defects (p.A596T in AR and p.G196S in SRD5A2) in a patient with hypospadias and novel 8 nucleotide deletion (exon 1) found in a patient with perineal hypospadias. Deficits in SRY, WT1, DHH, NR5A1, and DMRT1 caused 46,XY gonadal dysgenesis. Notably, mutations in AR, SRD5A2, MAMLD1, WT1, and MAP3K1 have led to hypospadias and only one CYP19A1 mutation caused aromatase deficiency was reported to date. Data mining from various databases has not only reinforced the role of well-established genes (e.g., SRY, WT1, DHH, NR5A1, DMRT1, AR, SRD5A2, MAMLD1) involved in DSD but also provided us 12 more potential candidate genes (ACVR1, AMHR2, CTNNB1, CYP11A1, CYP19A1, FGFR2, FGF9, PRKACA, PRKACG, SMAD9, TERT, ZFPM2), which benefit from a close association with the well-established genes involved in DSD and might be useful to screen owing to their direct gene-phenotype relationship or through direct functional interaction. As more genes have been revealed in relation to DSD, we believe ultimately it holds a better scenario for therapeutic regimen. Despite the advances in translational medicine, hospitals are yet to adopt genetic testing and counseling facilities in India that shall have potential impact on clinical diagnosis. Abbreviations: 5α-RD2: 5α-Reductase type 2; AIS: androgen insensitivity syndrome; AMH: antimullerian hormone; AMHR: antimullerian hormone receptor; AR: androgen receptor gene; CAH: congenital adrenal hyperplasia; CAIS: complete AIS; CAH: congenital adrenal hyperplasia; CHH: congenital hypogonadotropic hypogonadism; CXORF6: chromosome X open reading frame 6 gene; CYP19A1: cytochrome P450 family 19 subfamily A member 1 gene; DHT: dihydrotestosterone; DMRT1: double sex and mab-3 related transcription factor 1 gene; DSD: disorders of sexual development; GD: gonadal dysgenesis; HGMD: human gene mutation database; IH: isolated hypospadias; MAMLD1: mastermind like domain containing 1 gene; MIS: mullerian inhibiting substance; NTD: N-terminal domain; OT DSD: ovotesticular DSD; PAIS: partial AIS; SOX9: SRY-related HMG-box 9 gene; SRY: sex-determining region Y gene; STAR: steroidogenic acute regulatory protein gene; SRD5A2: steroid 5 alpha-reductase 2 gene; T DSD: testicular DSD; T: testosterone; WNT4: Wnt family member 4 gene; WT1: Wilms tumor 1 gene; Δ₄: androstenedione.

Generating toxic landscapes: impact on well-being of cotton farmers in Telangana, India

Existing literature demonstrates agro-chemicals result in physical toxicity and damages human health, flora and fauna. However, little is known about how such ‘toxicity’ relates to mental well-being and social suffering. This paper aims to demonstrate how local, national and international vectors are interlinked to shape social distress among cotton farmers in India. Ethnographic interviews and focus group discussions were conducted in a cotton-growing village of the Warangal district, Telangana state, India. The results advance the concept of counter therapeutic spaces and hypothesise that toxic landscapes emerge through a dynamic interaction between dispersed agencies that interact and reconfigure agricultural spaces into socially toxic places. The paper argues that the disciplines of public health and agriculture suffer from a failure of imagination to forge vital interdisciplinary links that could address farmer suffering. Unpacking local ecologies of farmer suffering offer innovative ways for enhancing mental health policy and interventions in India.

A transversion mutation in non-coding exon 3 of the TMC1 gene in two ethnically related Iranian deaf families from different geographical regions; evidence for founder effect

OBJECTIVES

Transmembrane channel-like 1 (TMC1) gene is a member of the transmembrane channel-like (TMC) gene family that encodes an integral membrane protein of the inner ear. It is suggested that mutation in this gene is one of the main causes of autosomal recessive non-syndromic hearing loss (ARNSHL) in different populations. The aim of this study was to determine the contribution of the TMC1 gene mutations in causing hearing loss in Iran.

METHODS

In total 54 unrelated Iranian families containing 159 affected individuals with ARNSHL detected by audiometric and otologic examinations were analyzed. Haplotype analysis of all members of 45 GJB2- & GJB6-negative families, using four microsatellite markers linked to DFNB7/11 was performed.

RESULTS

Co-segregation of hearing loss with all investigated markers for the DFNB7/11 locus was found in one family. DNA sequencing of all coding and non-coding exons and intron boundaries of the TMC1 gene identified c.-258A>C mutation in non-coding exon 3 only in individuals with hearing loss. This mutation has been previously reported in another Iranian family (G9) that share similar ethnicity. This variant was not detected in 300 ethnically matched healthy controls.

CONCLUSIONS

These results increase the probability that this nucleotide variation may be a pathogenic mutation. This study showed that the ethnicity may be more useful than geographical location to design research strategy for determining which genes should be considered when a heterogeneous disorder is under investigation.

Status and requirements of geriatric mental health services in India: an evidence-based commentary

In view of appreciable improvements in health care services in India, the longevity and life expectancy have almost doubled. As a result, there is significant demographic transition, and the population of older adults in the country is growing rapidly. Epidemiological surveys have revealed enormous mental health morbidity in older adults (aged 60 years and above) and have necessitated immediate need for the development of mental health services in India. The present population of older adults was used to calculate psychiatric morbidity based on the reported epidemiological data. The demographic and social changes, health care planning, available mental health care services and morbidity data were critically examined and analyzed. The service gap was calculated on the basis of available norms for the country vis-à-vis average mental health morbidity. Data from a recent epidemiological study indicated an average of 20.5% mental health morbidity in older adults. Accordingly, it was found that, at present, 17.13 million older adults (total population, 83.58 millions) are suffering from mental health problems in India. A differing, but in many aspects similar, picture emerged with regard to human resource and infrastructural requirements based on the two norms for the country to meet the challenges posed by psychiatrically ill older adults. A running commentary has been provided based on the available evidences and strategic options have been outlined to meet the requirements and minimize the gap. There is an urgent need to develop the subject and geriatric mental health care services in India.