Mental Health Impact of COVID-19 Infection on Postpartum Women from Lower and Middle-income Backgrounds in India and its Effects on Early Mother-infant Bonding: An Observational Study

The study was designed to examine the mental health impact of COVID-19 infection in postpartum women and its effects on mother-infant bonding during the first eight weeks postpartum. Fifty-seven consenting eligible postpartum women were recruited for the study. They were assessed at two time points using standardized rating scales to measure distress and uniquely designed scales assessing COVID-19-specific outcome fears and bonding. Almost half [42%] of postpartum women with COVID-19 suffered from a probable anxiety disorder, and one-third [33.3%] suffered from probable depression. The overwhelming majority [91.2%] experienced COVID-19-specific fear. There was an inverse relationship between one dimension of maternal caregiving and self-report depression and anxiety scores, respectively. Additionally, despite discharge, 25% of the mothers had not breastfed the infants till the 8th-week postpartum period, which is in discordance with the World Health Organization (WHO) recommendation of exclusive breastfeeding up to 6 months of age that is widely practiced in India. The novel COVID-19 pandemic was associated with anxiety and depression, impacting mother-infant bonding. Therefore, there is a need for specialized mental health services and individualized breastfeeding interventions for this vulnerable population to ensure positive outcomes.

Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Suicide is a global health issue that needs to be addressed. The COVID-19 pandemic has resulted in an increased mental health burden. Stigma has obstructed efforts to prevent suicide as individuals who need urgent support do not seek appropriate help. The influence of stigma is likely to grow in tandem with the COVID-19 pandemic. The stigmatization of persons with mental illnesses is widespread worldwide, and it has substantial effects on both the individual and society. Our viewpoints aim to address the probable link between stigma and suicide in the wake of the current pandemic and propose ideas for reducing suicide-related stigma.

A transdiagnostic evaluation of cortical inhibition in severe mental disorders using Transcranial Magnetic Stimulation

Multiple lines of investigations suggest the presence of cortical inhibition aberrations as central to the phenotypic manifestations of severe mental disorders. Transcranial Magnetic Stimulation (TMS) combined with electromyography can characterize these inhibitory processes in the motor cortex with satisfactory temporal precision. We examined TMS-evoked short- (SICI) and long-interval intracortical inhibition (LICI) and cortical silent period (CSP) as markers of GABA_A- (SICI) and GABA_B-mediated (LICI and CSP) cortical neurotransmission in symptomatic individuals with mania (n = 40), schizophrenia (n = 76), unipolar depression (n = 86), and OCD (n = 43), and compared them against similar recordings in healthy subjects (n = 125). We hypothesized transdiagnostic GABA_A deficits across all the clinical groups and diagnosis-specific GABA_B alterations in mania (increased) and OCD (decreased). After controlling for potential confounder variables (gender, education, benzodiazepine prescription, and motor threshold) using the ANCOVA, we observed no significant group difference in SICI (F = 1.04, P = 0.38), but a significant group effect in LICI (F = 16.29, P < 0.001) and CSP (F = 3.02, P = 0.018). Post-hoc analyses revealed that LICI was significantly reduced in OCD but increased in mania and schizophrenia with reference to the healthy group. Similarly, CSP was significantly reduced in OCD and depression groups as compared to the reference group. We observed that LICI and CSP, both followed similar descending gradients from mania through schizophrenia and depression to OCD; with significant elevation in mania, and reduction in depression and OCD, as compared to the healthy group. This pattern of GABA_B-mediated cortical inhibition aberrations needs independent validation as potential state-markers of distinct clinical categories.

Comparative study of the mental health impact of the COVID-19 pandemic on health care professionals in India

Aims: This study aimed to investigate how the psychological health of health care professionals (HCP) on COVID duty was different from those who were not directly in contact. Methodology: Of 473 (76%) randomly selected respondents (doctors and nurses) to a WhatsApp request message, 450 subjects' data were finally analyzed. Result: The prevalence of stress, anxiety and depression among HCP was 33.8, 38.9 and 43.6%, respectively. Compared with nonexposed professionals, COVID-19-exposed professionals had roughly double the score of these morbidities (t = 6.3, p < 0.001; t = 6.9, p < 0.001; t = 6.0, p < 0.001). Most worry (71.11%) was about the health of their family, followed by themselves (35.55%). Conclusion: The level of exposure, feelings of uncertainty and fear of infection emerged in our study as possible risk factors for psychological morbidities among HCP.

Bilateral continuous theta burst stimulation (cTBS) for treatment resistant auditory hallucinations and synesthesia in schizophrenia – A case report

Introduction

While 1–Hz repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing auditory hallucinations (AH), its effects are transient. cTBS, a patterned-rTMS technique induces sustained long-term-depression-like effects. Here, we demonstrate efficacy of twice daily, bilateral-cTBS in a patient with treatment-resistant AH, reflex hallucinations and vision-touch synesthesia.

Method

A 25-year-old male with 5 years history of treatment-resistant AH (2nd/3rd person), vision-touch synesthesia and reflex hallucinations. He was on a combination of 200 mg clozapine and 300 mg amisulpride for the last 6 months with no improvement. He received two-weeks of twice daily, bilateral-cTBS [40,1 s-trains (bursts of 3-pulses at 50 Hz every 200 ms) given continuously at 90% motor threshold] over the temporoparietal junctions located using the International 10/20 system. Amisulpride was stopped and clozapine was increased to 300 mg/day. Change in AH and synesthesiae were assessed using auditory hallucination rating scale (AHRS) and clinical interview.

Result

AHRS scores reduced from 35/41 to 0/41 at the end of 2 weeks, with substantial improvement being noticed at the end of the fifth day. Synesthesiae and reflex hallucinations also showed similar trends in improvement. No serious adverse events.

Discussion

Integration of auditory, visual and tactile perceptions is an important function of the temporoparietal junction. administering cTBS to this region bilaterally reduced our patient's perceptual abnormalities. Increasing dose of clozapine could be a confounding factor, however, the rapidity of treatment response enables us to attribute part of the improvement to cTBS.

Disclosure of interest

The authors have not supplied their declaration of competing interest.