Bedside cognitive assessments in Wilson's disease: Comparing cases and matched controls

Objectives

Wilson's disease (WD) is an autosomal recessively inherited disorder with a reported prevalence of 33-68/100,000 in Asian countries not including India. There is a paucity of research in India on prevalence, pattern, and profile of neuropsychological deficits among these patients. The objectives of the study were to profile neuropsychological differences between patients with WD and age- and education-matched healthy controls.

Material and Methods

A hospital-based, cross-sectional, and comparative study using strategic combination of neuropsychological tests. Persons with neurological WD receiving IP care over a 3-month period were compared with matched controls. The inclusion criteria were diagnoses of Chu Stage 1 and Chu Stage 2 neurological WD, age 15-45 years, illness of minimum 6 months, and diagnosis confirmed by low serum ceruloplasmin. Exclusion criteria were evidence or clinical suspicion of intellectual disability and past or current psychiatric illness.

Results

Median age of patients - 17.5, median age of controls - 18. R software was used to analyze the results. For all cases and controls, time taken to administer the set of tests was always <30 min. Non-parametric tests were chosen considering the data distribution. Statistically significant differences with P < 0.05 are noted in domains of processing speed, frontal executive function, focused attention, verbal, and visual memory in descending order.

Conclusion

A strategic compilation of easily performed bedside neuropsychological tests demonstrated differences between the two groups. This combination can be rapidly administered in the clinical setting and hence improve change tracking. This may aid in early identification and hence, earlier initiation of therapy with a possibility of improved clinical outcomes.

Public Health Perspectives of Geriatric Mental Health Care

BACKGROUND

In older adults (aged 60 years and above), mental health problems are gaining public health importance because of the increasing prevalence, disease burden, disability, morbidity, and mortality. Epidemiological studies on major mental health disorders such as depression and dementia in older adults have contributed to a better understanding of the distribution and determinants of these conditions. Identifying potential risk factors has stimulated interventional research on preventing these conditions under the public health framework towards their management. The increasing burden of geriatric mental health conditions like dementia in developing countries like India can contribute to significant challenges if there is no adequate strengthening of the public health response. This includes scaling up the measures of prevention, public awareness, early diagnosis, and quality health and social care equitably available to all sections of the population. The Decade of Healthy Ageing (2021-2030) provides the opportunity for concerted and coordinated initiatives to improve intrinsic capacity (physical and mental) and offer an age-friendly environment to enhance the functional ability of all older adults.

METHODS

This article reviews the critical public health issues related to geriatric mental health in India.

Reasonable Accommodation at the Workplace for Professionals with Severe Mental Illness: A Qualitative Study of Needs

BACKGROUND

Professionals with Severe Mental Illness (PwSMI) often face challenges in obtaining and retaining employment. For equal and effective participation, they may require reasonable workplace adjustments. The recently legislated Rights of Persons With Disabilities Act 2016 in India defines such adjustments as reasonable accommodations.

METHODS

In-depth qualitative interviews were conducted with 15 consenting PwSMI availing psychiatric rehabilitation services at a tertiary mental health institute in India, five mental health professionals, and five employers. The audio-recorded interviews were transcribed and coded manually by two independent investigators. Inductive content analysis approach was used for qualitative analysis.

RESULTS

The detected themes included modifications in work schedule, supports to improve work efficiency, modifications in the work environment, modifications in the work-related appraisal, supportive employer policy, and integration of services. The participants described the term "undue burden" to be ambiguous.

CONCLUSIONS

The reported reasonable accommodations are non-structural and mainly dependent on human assistance. Vocational rehabilitation and job reintegration efforts can focus on guided negotiations between employers and PwSMI. This is dependent on at least some degree of disclosure. Awareness regarding reasonable accommodation and stigma reduction is necessary for successful implementation.

Advance directives and nominated representatives: A critique

With the ratification of the landmark United Nations Convention on Rights of Persons with Disabilities by India, it was imperative to revamp the mental health-care legislation, among other changes. Most notably, a presumption of mental capacity has been introduced, which means a paradigm shift in the client and provider relationship. The Mental Healthcare Act, 2017 empowers all persons to make advance directives (AD) and nominate representatives for shared decision-making. Psychiatric ADs (PADs) also seem to improve the information exchange between the care provider and the service user. PADs may also be used as a vehicle of consent to future treatments. While drafting the PAD, the drafter must also plan how such directed care would be financed. Insurance companies have not been mandated to comply with ADs. In the eventuality that the drafter's family refuse support for treatment specified in the PAD, the drafter would be left holding an unimplementable PAD. The AD saw its origins in the care of the terminally ill and decades later came to be utilized in mental health care. After nearly three decades of use in developed countries, evidence at best remains mixed or inconclusive. This review focuses on the AD from the Indian perspective.

On one-dimensional nucleation and growth of "living" polymers I. Homogeneous nucleation

The kinetics of one-dimensional polymerization are described in terms of successive monomer additions. During homogeneous nucleation, the concentration cn of critical nuclei is proportional to the nth power of monomer concentration c1 and, initially, to the (n - 1)th power of time.

On one-dimensional nucleation and growth of "living" polymers. II. Growth at constant monomer concentration

An analytical solution is given for the kinetics of reversible homogeneous one-dimensional growth, assuming that all association rate constants have the same value k, that all dissociation rate constants are likewise equal to k, and that the monomer concentration has a constant value, C. Such growth tends to generate a maximally polydisperse ("white") distribution of cluster concentrations ci, all approaching a limiting value equal to that of the critical nucleus, cn. Continued growth merely increases the range of cluster sizes over which this white distribution applies. A simple expression is obtained for the flux sigma infinity i = n dci/dt, which becomes constant and equal to (kC - k)cn. The monomer uptake increases with time, and is given approximately by (kC - k)2cnt.

On the adsorption of phloretin onto a black lipid membrane

The effect of uncharged, dipolar phloretin on anion and cation conductance through a black lipid membrane can be used to study its adsorption behavior. The adsorption of phloretin can be described by a Langmuir isotherm with weak dipole-dipole interaction.

On the ionic displacement current in lipid bilayer membranes

It is shown that the constant field approximation must be amended to make it apply to time-dependent signals. The necessary additional term corresponds to the ionic displacement current. In the absence of adsorption, this ionic displacement current is found to have a characteristic time of the order of a fraction of a microsecond. We confirm its mathematical form as given by Cole (1965). When the membrane-soluble ions are strongly adsorbed, an additional, purely exponential transient of much larger time constant is calculated, with a time dependence identical to that of the translocation of adsorbed ions. Our results support the pseudostationary approximation used by Andersen and Fuchs (1975) in the description of such exponential transients. Explicit expressions are given for the current after a voltage step as for the admittance, both in the absence and presence of adsorption, for a membrane with a rectangular potential energy profile.

Faradaic Admittance and Migration in the Diffuse Double-Layer: Effect on the Phase Angle

The effect of migration in the diffuse double-layer on the phase angle between the alternating components of the faradaic current and voltage is discussed. It is shown that the cot � v. √ω relationship is nonlinear and the modified equation for this case (i.e. when migration is taken into account) is given. Equations derived already by Matsuda are discussed. Theoretical studies on the variation of ((Io)app/(Io)ms with Gouy potential are also reported.