Background The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. Aims In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. Method From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. Results A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. Conclusions This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Preschool onset of obsessive-compulsive disorder (OCD) is rare with limited studies on it and with multiple diagnostic and treatment quandaries. We report a case of 5-year-old girl who had obsessive-compulsive symptoms since 4 years of age. She was diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria after eliminating other potential diagnoses. She showed good response to a combination of parent-assisted exposure and response prevention therapy and fluoxetine. This case brings into focus the distress associated with very early onset of OCD and discussion of differential diagnoses and treatment options for it.

Background: There is a paucity of studies exploring the role of ketamine as augmenting agent to conventional antidepressants. Materials and methods: Sixty patients with major depressive disorder (MDD) were randomized to 4 weeks' double-blind treatment with escitalopram 10 mg/day + single-dose intravenous (IV) ketamine (0.5 mg/kg over 40 minutes) or escitalopram 10 mg/day + placebo (0.9% IV saline). Depressive symptoms were measured using the Montgomery-Asberg depression rating scale (MADRS), adverse effects were measured with the brief psychiatric rating scale (BPRS), young mania rating scale (YMRS), and clinician administered dissociative states scale (CADSS).Patients were assessed at baseline, 4, 24, and 48 hours and 7 days and 28 days. Response (50% MADRS score reduction) was the primary outcome. Results: The MADRS scores showed significant reduction in the group receiving ketamine as compared to group receiving placebo at 4, 24, and 48 hours, 1 week, and 28 days (p < 0.001). By 4 weeks, compared to escitalopram + placebo-treated patients, more of escitalopram + ketamine-treated patients responded (80% vs 20%) and remitted (21.67% vs 0%). Rapid response was evident at 4 hours in ketamine group as compared to placebo (36.67% vs 0%). Both CADSS and YMRS scores were significantly higher (p < 0.001) in the ketamine group as compared to the placebo group at 4 hours but not at 24 and 48 hours and 7 and 28 days. Conclusion: Single-dose IV ketamine as an add-on to 10 mg/day escitalopram is efficacious, resulting in more rapid and robust response over 4 weeks. Dissociative and mania-like symptoms emerging post-infusion are mild and transient, not warranting treatment discontinuation. Further research into the role of ketamine augmentation in MDD is required for its clinical applicability.

Background: Hysterectomy is the most common major gynecological surgery often performed for benign lesions. Many studies have reported adverse psychosocial outcomes post-hysterectomy. There is a paucity of studies from India addressing psychiatric morbidity after hysterectomy. To evaluate psychological wellbeing, marital adjustment and quality of life in patients undergoing hysterectomy for non-malignant conditions, in comparison with patients undergoing surgery other than hysterectomy.Methods: A cross-sectional study was conducted on 100 consecutive out-patients who underwent hysterectomy for non-malignant indications at least 6 months ago. The comparison group comprised of 50 consecutive out-patients who underwent gynecological surgery other than hysterectomy at least 6 months ago formed the comparison group. The study participants were evaluated on Hospital Anxiety and Depression Scale (HADS), Psychological General Well-being Index (PGWBI), Marital Adjustment Test (MAT) and Women’s Quality of Life Questionnaire (WOMQOL).Results: The indications for hysterectomy were: uterine leiomyoma (69%), uterovaginal prolapse (18%), dysfunctional uterine bleeding (12%), and endometriosis (1%). Abdominal hysterectomy was performed in 92 patients while 8 patients underwent vaginal hysterectomy. There were no significant differences in the study groups on scores of HADS, PGWBI, MAT and WOMQOL (p>0.05). Both the study groups had good marital adjustment and majority reported no depression and anxiety.Conclusions: There is no major psychiatric morbidity, decline in marital adjustment and quality of life after hysterectomy for benign conditions among Indian women. Future research on the ethno-cultural implications and effect of hysterectomy on mental health will be a significant addition to the available evidence in India.