Vikas Menon

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Background: Digital mental health interventions (DMHIs) offer a potential solution to bridge the considerable treatment gap in mental health service delivery. Our objectives were to qualitatively examine barriers, facilitators, attitudes, and preferences toward DMHIs among patients with severe mental illness (SMI) and their caregivers. Methods: In-depth interviews were conducted with remitted patients with schizophrenia or bipolar disorder and their caregivers. A semi-structured interview guide with open-ended questions and prompts was used. Interview sessions were audio-recorded and transcribed verbatim. Descriptive open coding was done. Generated inductive codes were arranged first into categories and then into themes. Results: Twelve patients with SMI and 12 caregivers were interviewed. Key barriers to the use of DMHIs were perceived ineffectiveness of technology-assisted consults (compared to in-person visits), perceived adverse effects, inadequate digital literacy, cognitive barriers such as forgetting details during teleconsultations, and concerns about confidentiality. Key facilitators included convenience, wide reach and availability, willingness to adapt, shared access to devices in households, and the potential of DHMIs to increase awareness about mental illness. Attitudes toward DMHIs were ambivalent, with concerns about technology-mediated clinical interactions but openness to personalized service delivery through technology, such as medication and appointment reminders, and toll-free contact numbers for emergencies. They also emphasized the importance of raising awareness about mental illness through DMHIs. Conclusions: Patients with SMI and their caregivers identified significant structural and individual barriers to the use of DMHIs. We suggest that DMHIs for this group should be co-designed to address their needs and concerns, thereby enhancing uptake.

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Background: Cognitive deficits in anxiety disorders (ADs) contribute to clinical and socio-occupational dysfunction, necessitating targeted interventions. Novelty: Integrated cognitive control training (ICCT) has demonstrated benefits in other disorders; however, it remains unexplored in ADs. With its process-specific training and multi-pronged exercises for stimulation, metacognitive training, and generalization, it has potential for enhancing cognitive functions and reducing anxiety symptoms in ADs. Objectives: This article describes the study protocol for a multi-site randomized controlled trial to test the efficacy of ICCT in individuals with ADs. Methods: Adults diagnosed with ADs ( n = 100) will be recruited across two sites. Following baseline assessments, they will be randomized to either ICCT (eight weekly sessions) or treatment as usual. ICCT will be delivered through once-weekly therapist-guided, smartphone app-based (CogTrain) homework (20–30 min/session, 4–6 times/week). Multimodal assessments will be carried out at baseline, post-intervention (10–12 weeks), and follow-up (20–24 weeks). The primary measure comprises the Hamilton Anxiety Rating Scale, with secondary measures of the Work and Social Adjustment Scale (socio-occupational functioning), neuropsychological tests (attention, memory, and executive functions), and functional magnetic resonance imaging of the cognitive control (CC) circuits. Intervention feasibility and acceptance metrics (response rate, intervention relevance) will also be recorded. Quality assurance and ethical procedures will be documented. Expected Outcome: The ICCT is expected to enhance cognitive functioning in adults with ADs, in addition to reducing symptoms, altering the underlying neural circuits of CC, and improving overall functioning. Digital delivery via a smartphone app may provide a cost-effective, scalable intervention useful in resource-constrained settings.

Background: Synaptic plasticity markers are known to be altered in schizophrenia. Purpose: The objectives of the study were to analyse neurexin-3 levels and their relation with severity in schizophrenia. Methods: A total of 216 schizophrenia patients and 216 healthy volunteers were enrolled. Neurexin-3 was analysed by enzyme-linked immunosorbent assay. The severity of schizophrenia was determined using the Positive and Negative Syndrome Scale (PANSS) scores. Results: Neurexin-3 levels were significantly reduced ( p < .001) and positively associated with negative symptom score ( p = .037), general psychopathological score ( p = .025) and total PANSS score ( p = .019) in schizophrenia cases. Neurexin-3 was significantly increased ( p < .05), and disease duration ( p < .05) was significantly reduced in schizophrenia patients with marked illness compared to those with mild illness. Conclusion: We conclude that neurexin-3 is reduced and is associated with the severity of schizophrenia.