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   Table of Contents - Current issue
July-September 2019
Volume 4 | Issue 3
Page Nos. 51-75

Online since Wednesday, August 7, 2019

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Mindfulness-based cognitive therapy for University students with depression, anxiety, and stress symptoms: a randomized controlled trial p. 51
Alessandra Almeida Assumpcao, Carolina Silva Pena, Carmem Beatriz Neufeld, Maycoln M Teodoro
Background and objectives: Early detection and intervention of depression, anxiety and stress symptoms in college can reduce the incidence of future mental health problems, thereby achieving better academic performance and having a positive effect on future career. The effect of Mindfulness-Based Cognitive Therapy (MBCT) on stress, depression and anxiety symptoms in this population has not been fully studied. The study aims to evaluate the efficacy of MBCT in treating depression, anxiety and stress symptoms in college students. Subjects and methods: This is a randomized parallel-controlled trial. University students with depressive, anxiety and stress symptoms were randomized into MBCT group and wait-list control (control) group. The MBCT took place in a weekly meeting within 6 weeks and was delivered in groups constituted by 5–11 participants. Each meeting took 90 minutes. The primary outcomes were the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Perceived Stress Scale. The secondary outcomes were the Rosenberg Self-Esteem Scale, and the 12-Item Health Survey scores. The study protocol was approved by the Ethics Committee of Federal University of Minas Gerais, in Belo Horizonte, Brazil (approval No. 2.025.573) on April 20, 2017. Results: The MBCT intervention had a statistically significant reduction in depression levels at post-treatment, and the treatment gains were maintained in follow-up (P < 0.05). Besides, the intervention increased the quality of life in post-test follow-up (P < 0.05). Conclusion: The MBCT helps college students learn how to manage adverse emotional states, especially, depression. It also helps improving their quality of life. Trial registration: This trial was registered in the Brazilian Clinical Trial Registry (http://www.ensaiosclinicos.gov.br) (registration No. RBR-4mmvpc) on July 21, 2017. Funding: This study was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES; to AAA).
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Bacteriological profile of endotracheal tube aspirates in head injury patients admitted in Neurosurgical Intensive Care Unit: a cross-sectional study from a tertiary care hospital of Central Nepal p. 60
Joe M Das, Sanjana Rajkumari, Shova Dangol, Rashmi Sapkota, Manish Mishra
Background and objectives: Many head injury patients have reduced consciousness, are prone to aspiration of oral secretions and likely develop pneumonia. The organisms causing such infection and their antibiotic susceptibility will vary from patient to patient. The aim of this study was to identify the common organisms which cause respiratory tract infection in Neurosurgical Intensive Care Unit, investigate their antibiotic susceptibility, and try to prepare a common antibiotic formulation which can be started empirically. We also intended to find out the antibiotic resistance of these different types of bacteria. Subjects and methods: We conducted a retrospective cross-sectional study for a period from January to June 2018 in patients who were admitted with head injury in Neurosurgical Intensive Care Unit. All those having endotracheal tubes for assisting respiration for ≥ 3 days were included in the study. Endotracheal tube aspirate was obtained on the 3rd day of admission. We recorded age, sex, Glasgow Coma Scale score at the time of admission, the respiratory pathogen isolated, and its antibiotic susceptibility and resistance as identified by bacterial culture. Statistical analysis of data was done to find out if there was any age or sex-wise distribution of the organism and to which antibiotic most of the organisms responded. This study was approved by the Institutional Review Committee of The College of Medical Sciences - Teaching Hospital, Bharatpur on November 28, 2017. Results: The types of bacteria isolated from endotracheal tube aspirate were Acinetobacter baumanii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Enterobacter species. Among all the antibiotics which were tested for sensitivity, Meropenem was the only one that was found to be consistently sensitive to all the above bacterial species. Conclusion: If we are encountering a respiratory tract infection in an intubated head injury patient, Meropenem is a potential antibiotic which can be the empirical drug of choice till the final culture and sensitivity are reported.
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Effectiveness of inpatient alcohol detoxification and psychotherapeutic support program: a prospective self-controlled study at a tertiary hospital in Nepal p. 66
Suraj Shakya, Jug Maya Chaudhary, Pramesh Man Pradhan, Saroj Prasad Ojha, Mita Rana
Background and objectives: Alcohol use disorder is prevalent or common and associated with a range of physical and mental sequelae. Treatment gap exists in low and middle income countries. This study aims to evaluate effectiveness of inpatient detoxification with concomitant psychotherapeutic support in terms of readiness to change and abstinence maintenance. Subjects and methods: This prospective self-controlled study included 109 patients admitted for alcohol use disorder (age: 42.5 ± 9.3 years; male: 90.8%) in a tertiary level hospital (inpatient unit at Department of Psychiatry and Mental Health at Tribhuvan University Teaching Hospital in Kathmandu). They underwent 10–14 days of inpatient detoxification and psychotherapeutic support program. Baseline assessments were done during admission, and follow-ups were done just prior to discharge, 2 weeks and 3 months after discharge. After 3 months, 63 participants were contacted through phone. Primary outcome measures were readiness for change, reflected in scores on The Stages of Change Readiness and Treatment Eagerness Scale, and status of abstinence maintenance. Ethical approval was taken from Institutional Review Board, Institute of Medicine, Tribhuvan University on December 29, 2017. Results: Results showed statistically significant reduction in “ambivalence,” and improvement in “taking steps” during discharge as well as 2 weeks after discharge in comparison to the baseline measures (P < 0.001). However, there was no significant change in “recognition.” In the 3-month follow-up, 73% of the participants were in complete abstinence; 6.3% had few drinks (up to three drinks) on a couple of occasions; and 20.6% relapsed. Conclusion: Brief inpatient treatment, incorporating pharmacological detoxification as well as psychotherapeutic support helps in enhancing readiness to change as well as maintaining alcohol-free lifestyle. Scaling up such packages to reduce treatment gap in low and middle income countries like Nepal is highly needed. Trial registration: This trial was registered in ClinicalTrials.gov (NCT03988478).
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Treatment with a halved dose of antipsychotics in patients with schizophrenia who relapse while receiving high-dose antipsychotic therapy p. 72
Ryota Ataniya
This study proposed and discussed a new treatment for patients with schizophrenia who relapse while receiving high-dose antipsychotic therapy. There is no drug therapy available for such patients. However, antipsychotic dose reduction by half may lead to remission. The positive symptoms of schizophrenia relate to increased striatal presynaptic dopamine availability and chaotic phasic firing of dopaminergic neurons in the striatum. Dopamine levels and its function in dopamine receptors show an inverted U-shaped curve relationship, which indicates that excessively high or low dopamine levels result in decreased dopamine activation. A halved dose of antipsychotics leads to excessive increase in subcortical dopamine levels and decreased dopamine function, resulting in the improvement of positive symptoms. Furthermore, there is a negative correlation between subcortical dopamine activity and the prefrontal cortex function; therefore, reduced mesostriatal dopamine activity may lead to increased prefrontal cortex function. The recovery of prefrontal cortex function may minimize impulsive or risk behaviors. The incidence of adverse events is similar after abrupt withdrawal or tapering of antipsychotics, except for the emergence of withdrawal dyskinesia. A halved dose of antipsychotics is effective for patients with schizophrenia who relapse while receiving high-dose antipsychotic therapy. Thus, we investigated whether an abrupt change to halved dose of antipsychotics improves positive symptoms and evaluated the efficacy of such treatment.
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