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| REPORTS |
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| Year : 2021 | Volume
: 3
| Issue : 3 | Page : 234-333 |
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Abstracts of the WASP Asia Pacific Hybrid Congress 2021
| Date of Submission | 14-Nov-2021 |
| Date of Acceptance | 14-Nov-2021 |
| Date of Web Publication | 23-Dec-2021 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wsp.wsp_60_21
How to cite this article:
. Abstracts of the WASP Asia Pacific Hybrid Congress 2021. World Soc Psychiatry 2021;3:234-333 |
| Plenary Session | |  |
| Plenary I: Vincenzo Di Nicola (Canada) | | |
| The Gurū–Chelā Relationship Revisited: A Review of the Work of an Indian Psychiatrist Jaswant Singh Neki | | |
Vincenzo Di Nicola
University of Montreal, Canada
E-mail: [email protected]
Abstract
In a series of original and pathbreaking publications, Jaswant Singh Neki (1925–2015), a leading Indian Sikh scholar and psychiatrist (Wikipedia contributors, 2021), proposed the gurū–chelā (master–disciple) relationship to create a new paradigm for the therapeutic relationship, employing an accessible cultural idiom that Indian patients could understand and identify with Neki, 1973, 1974, 1975, 1976, 1977, 1978, and 1992. Contrasting his new Indian paradigm with the Western patient–therapist relationship, Neki explored both similarities and sharp contrasts between Western and Indian cultures. Neki argued (1974) that “both are voluntary associations wherein a master enables a change seeker to dispel ignorance and the effects of undesirable social conditioning.” Using ideas adapted from Raymond Prince, one of the founders of Social and Cultural Psychiatry at McGill University, the author identifies the “I-centered assumptions” behind Western-based psychotherapy: based on the individual as the focus of therapy, using introspection and insight as key therapeutic methods, with personal independence as the goal of therapy (Di Nicola, 1985a, 1985b, and 1997). The gurū–chelā relationship, by contrast, “encourages permanent dependency, since the guru assumes total responsibility for leading the chela toward self-mastery through the disciplines of persistence and silence,” and would be “most suited to cultures valuing self-discipline rather than self-expression, and creative harmony between individual and society” (Neki, 1974; emphasis added). The author will take stock of the impact of Neki's paradigm in India (Carstairs, 1980; Parkar, et al., 2001; and Sethi and Chaturvedi, 1985), in the Indian diaspora (Shridhar, 2008), and in Western (Di Nicola, 1985a, 1985b, and 1997) psychiatric and psychotherapeutic cultures, concluding with a synthesis of Neki's gurū–chelā paradigm with contemporary trends in psychotherapy, psychiatry, and psychoanalysis.
| Plenary II: Afzal Javed (UK) | | |
| Financial Empowerment of Mentally Ill: Future Perspective and an Experience from a Developing Country | | |
Afzal Javed1, 2, 3
1Institute of Applied Health Research, University of Birmingham, 2Warwick Medical School, University of Warwick, England, UK, 3Pakistan Psychiatric Research Centre, Lahore, Pakistan
E-mail: [email protected]
Abstract
According to the WHO and World Bank, mental health issues impose an enormous disease burden on societies across the world. Despite its huge social burden, mental disorders continue to be driven into the shadows by stigma, prejudice, and fear along with financial issues. Outcome in most of the mental illnesses is often conceptualized in terms of remission, recovery, and relapse. An adequate definition of recovery has long been elusive, with very different definitions occurring in the scientific and patient's perspectives. However, importance of social functioning, financial autonomy, and reintegration into community highlights recovery as a process toward achieving, among other things, empowerment, hope, and respect. The consequences of poor financial mental health are found in data related to both morbidity and mortality. Financial empowerment is also a part of strengthening the families. It not only refers to a state wherein the individuals experience feelings of being worthy and competent but also having power and control. Financial mental health, therefore, is considered a construct in its own right, because the impacts are great. It acknowledges that socioeconomic status and mental health are interdependent. This does not imply, however, that wealth is a protector from mental illnesses or that poverty ensures it. Rather, the construct recognizes the interplay between those factors, which often are managed in silos, and the notion of financial mental health can be used to inform resiliency-building behaviors and identify gaps in institutional approaches to supportive services. This presentation will highlight the importance of empowerment and financial autonomy for improving the social functioning of mentally ill. The paper will also describe an innovative program that is being practiced in Pakistan. Based on the concepts of microfinance, this project has provided a new direction for a successful and sustained recovery process while improving social and financial aspects of day-to-day life of patients attending this psychosocial rehabilitation program in Lahore, Pakistan. The presentation will also give a brief account of this program, its relevance, application, and appropriateness for developing better services for patients with long-term needs.
| Plenary III: Eliot Sorel (USA) | | |
| COVID-19: Pandemic, Syndemic, Endemic Aspects and Social Contract Challenges | | |
Eliot Sorel
School of Medicine and School of Public Health, The George Washington University, Washington DC, USA
E-mail: [email protected]
Abstract
This autumn 2021 will be 2 years since the COVID-19 pandemic erupted in Wuhan, China. It has rapidly engulfed the whole world. Its exact origins remain unresolved. The World Health Organization has now established a working group to address these high-priority public health issues of the pandemic's origins so that we can more effectively deal with it now and also to be better prepared for the next pandemic when that occurs. The COVID-19 pandemic has caused 212 million infections and nearly 5 million deaths worldwide with no end in sight. It has markedly impacted countries' economies, across, low, middle, and high income, and has greatly undermined health and educational systems. The convergence of this pandemic with multiple, comorbid noncommunicable diseases and with rapidly evolving global climate change is generating a syndemic without precedent in world history. It is rapidly evolving, with devastating consequences for all living human and animal species, as well as, for the flora of our planet, the deteriorating quality of the air and water. A massive challenge faces us all. In the mid of this devastation, the accelerated vaccine development, saving millions of lives, is a welcome silver lining of this cloud hanging over all humanities. The paradox of vaccination resistance in some countries versus those around the world who desperately want it; the need for solidarity and vaccine accessibility globally continues to be a challenge; without a proper resolution of these vexing issues, more millions of lives will be lost, and we are likely to move from a pandemic to an endemic scenario. We welcome, in this context, the World Health Organization's innovative solidarity project on treatment developments with several countries participating across economies. The author addresses the COVID-19 global public health continuing emergency and its lack of resolution to date in the context of social contracts (and the mutual responsibilities we have for each other) and reflects on possible solutions and indications for enhanced preparedness.
| Plenary Symposium: Innovations in Social Psychiatry Across the World | | |
| Marianne Kastrup (Denmark), Fernandes Lolas (Chile), Andrew Molodynski (UK), Debasish Basu (India), Shiro Suda (Japan) | | |
| Fernandes Lolas: Challenges for Ibero-American Psychiatry from a Moral Standpoint | | |
Fernandes Lolas1,2
1University of Chile, 2Central University of Chile, Santiago, Chile
E-mail: [email protected]
Abstract
Departing from the notion that psychiatry as a discipline renovates through invention, innovation, and transformation, this paper presents an approach to the syncretic characteristics of Ibero-American psychiatry stressing the essential role of translation in the reception, adoption, and implementation of knowledge and practices developed in other regions of the world. This applies both to scientific and humanistic dimensions of psychiatry, considering that as a praxiology or science of actions deals with embodied persons embedded in cultures that need to be considered in the process of diagnosis, treatment, and prevention. This involves translational humanities considering that basic axioms concerning human nature need a reflective equilibrium between beliefs, constructs, and real conditions of practice. The innovations put forward by Ibero-American psychiatry, and expressed through modifications in institutions and concepts, can be studied against the background of the moral determinants of health, a comprehensive concept beyond the usual conceptualization of social determinants. The limitations imposed by scarce resources, shortage of trained practitioners, political instability, poverty, and economic dependence are a reminder that the challenges ahead are not only technical but moral as well.
| Andrew Molodynski (UK): Innovations in Social Psychiatry across the World | | |
Andrew Molodynski
Oxford, England, UK
E-mail: [email protected]
Abstract
Over recent decades, biological approaches to the “management” of people with serious mental health problems have dominated psychiatry, especially in wealthy countries. However, it has always been clear to enlightened clinicians and policymakers that the environment is crucially important too and that interventions to support people, families, and communities can make real differences in an individual's outcome after a period of illness. The events of the last 18 months globally have underlined the importance of community and support and that we must measure the progress of society in more than just GDP figures. The World Association of Social Psychiatry has a leading role to play in the renaissance of social approaches to mental health care globally. This talk describes a World Association of Social Psychiatry initiative that hopes to bring together a disparate group of charities, researchers, mental health workers, and patient groups to help each other and support each other's initiatives in social psychiatry.
| Debasish Basu (India): Innovations in Social Psychiatry across the World – India | | |
Debasish Basu
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
E-mail: [email protected]
Abstract
India is a large country with a huge population, high mental illness burden, and a substantive treatment gap, with inadequate infrastructure, human resources, and funding related to mental health care. Given this challenging scenario, innovations utilizing social psychiatric principles have come from the government sector, nongovernmental organizations, and like-minded professional associations. The focus has been on integrating mental health care with primary health care, reducing stigma, early detection, enhancing access to affordable care, continuity of care, and promoting recovery and social integration. Digital technology is being increasingly explored to partly further these goals. Although there have been appreciable improvements, there is a long way to go!
| Shiro Suda (Japan): Web-Based Surveys for Social Psychiatry in the Post-COVID-19 Era | | |
Shiro Suda
Department of Psychiatry, Jichi Medical University, Shimotsuke, Japan
Abstract
Due to the novel coronavirus disease (COVID-19) pandemic, most of the human activities through direct people-to-people contact have been strictly restricted on the global level. The latest Olympics, Tokyo 2020, was held behind closed doors with unprecedented way. The COVID-19-related stagnation of human activities has also made a strong impact on the research activities. Studies other than laboratory works, especially field works in sociological studies with face-to-face interviews, are becoming difficult to implement. Together with development of information technology society, collection rate of paper-based questionnaire surveys is declining. For instance, the collection rate of the Japanese National Survey of Social Stratification and Social Mobility, which is conducted by random sampling method and taken decade after decade since 1955, fell 50% from 80% in this century. The benefit of random sampling survey that was considered a golden standard is now decreasing. Web-based survey is a data collection method that participants submit the answers of questionnaire by clicking the website and is rapidly developing in the last two decades. In the early days of this study method, strong biases due to sample selection and purpose of participation, i.e., most of the participants would obtain some tokens by answering questionnaire, had been emphasized. However, the growing of the Internet user population across all generations and the responding increase of the enrollment of the web research companies, the problems due to the biases has been improving. In this presentation, pros, cons, and future directions of web-based survey will be discussed.
| Plenary IV: Tom Craig (UK) | | |
| Public Mental Health Consequences of COVID-19: any Surprises? | | |
Tom K J Craig
Institute of Psychiatry, Psychology and Neuroscience, King's College, London, England, United Kingdom
E-mail: [email protected]
Abstract
Mental health consequences of the COVID-19 pandemic in the UK have raised major concerns in the press and among mental health-care professionals with some expressing fears that mental health services could be overwhelmed. But have these fears been realized? In this presentation, I will provide a narrative review of publication and rapid access preprint papers documenting the mental health impact of the pandemic in the UK between April 2020 and January 2021. Much of the information is based on a well-established UK household survey that has been running for several years that provides helpful relevant data from the prepandemic period.
| Plenary V: Driss Moussaoui (Morocco) | | |
| Psychological Help in Rural Areas: What is Necessary and What is Feasible? | | |
Driss Moussaoui
President, International Federation for Psychotherapy
E-mail: [email protected]
Abstract
The burden of diseases of mental disorders is one of the highest in the medical field, including in low- and middle-income countries. The treatment gap is higher in psychiatry than in other medical specialties, especially for psychological treatments. Rural and remote areas are not well served when it comes to psychopharmacological treatments, not to mention psychotherapy. Paramedical staff in rural areas, when they exist, are the only health resource helping sometimes large populations. Their training and their professional development (when it exists) should focus also on how to help psychologically those in need. In case they are nonexistent, it could be good to train laypeople on what to do and what not to do when a mental disorder occurs in a person of the village. Scattered experiences exist around the world in Brazil, Cameroon, Pakistan, and other places. A brief description will be made of the pilot project “Psychological Help in Rural Areas” currently taking place in Morocco, and which was initiated by the International Federation for Psychotherapy.
| Plenary VI: Swaran Preet Singh (UK) | | |
| Early Intervention in Psychosis: delivering More Than You Promise | | |
Swaran P Singh
University of Warwick, Coventry, England, UK
E-mail: [email protected]
Abstract
Early intervention in psychosis (EIP) services has been described as the most positive development in mental health services since the beginning of community care. Clinically, the growth of such services, now mainstream in England and in many parts of the developed world, has been particularly welcomed by service users and their carers. Duration of untreated psychosis has fallen dramatically in England since the introduction of EIP as part of routine care in the National Health Service, UK. Extending the paradigm of early intervention into the prepsychotic phase and for undetected cases in the community has spurred the development and testing of several new interventions which make prevention in psychosis a feasible and tangible objective. EIP has also fostered therapeutic optimism both among service users and providers, with vocational outcomes being particularly positive for young people with emerging psychosis. Yet, some detractors still portray EIP as oversold “hype” – one that has could not possibly deliver on all its supposed promise. This lecture will briefly outline the history of the development and implementation of EIP in England, Australia, and Canada and describe the different meanings of the term and the varying levels of evidence for each form of early intervention, highlighting the promising gains of EIP and new avenues for clinical interventions and research. I will also present recent evidence showing that the principles of EIP can be extended to other youth mental disorders and be applied in resource-poor settings such as low- and middle-income countries.
| Plenary VII: Pratap Sharan (India) | | |
| Plenary VIII: PratimaMurthy (India) | | |
| Rethinking Recovery in Mental Illness Integrating Physical and Mental Health | | |
Krishna Prasad Muliyala, Pratima Murthy
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Multimorbidity is the co-occurrence of more than one chronic condition. Multimorbidity is likely to rapidly rise in low- and middle-income countries (LAMICs). Multimorbidity involving noncommunicable diseases and mental illness negatively impacts quality of life and clinical recovery in both the conditions. Most health systems and programs cater to single diseases. In this article, we discuss the extent of the problem, potential challenges, and opportunities with focus on LAMICs exemplified by India. Integration of care is required in the context of multimorbidity. These can be provided in the existing national programs in India. Service provision needs to become personal recovery oriented. Service users should be engaged in the development of services and research in this area. Existing models emphasize self-management/self-care and provider–patient partnership. These need to be adapted and tested for feasibility in LAMICs.
| Plenary IX: Roy Abraham K (India) | | |
| The Need for a Paradigm Shift to Person-Centered Medicine during Pandemic Times | | |
Roy Abraham Kallivayalil
Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
E-mail: [email protected]
Abstract
SARS-CoV-2 infection has completely changed how the world looks at medicine. Unfortunately, the focus has been on the physical health epidemiology, clinical features, prevention of transmission and management, and very little focus on mental health and stigmatization. The 2019 coronavirus disease (COVID-19) has caused universal psychosocial impact by causing emotional disturbances, economic burden, and financial losses on a massive scale. Effects such as posttraumatic stress disorder, depression, anxiety, obsessive–compulsive symptoms, and insomnia in the postinfection period have been reported among COVID-19 survivors in. With disease progression, clinical symptoms become severe and psychological problems in infected patients will change; therefore, psychological intervention measures should be targeted and adapted as appropriate. COVID-19 surge which had happened in India was an unprecedented public health crisis. With exponential growth in the number of daily COVID-19 cases since March 2021, India reported more than 400,000 new cases daily on May 1, 2021. India's COVID-19 surge could have become a regional disaster impacting all of South Asia. However, India has successfully avoided that disaster by strengthening of surveillance systems, imposing travel restrictions, lockdowns, and mandatory travel quarantine for individuals returning from infected areas. These were necessary to control the spread of SARS-CoV-2. The situation in India required urgent, bold measures and close cooperation between India and the global community. This was done, and the pandemic has been brought under control. Currently, free vaccinations for the whole population are being given. With 1.4 billion people, this is going to be a massive effort. The pandemic and the aftermath need a paradigm shift from our traditional medical care models to one that is person centered. We have studied the resilience among the frontline physicians in India. Fear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of health-care workers, effective risk communication for their health, and finally, social inclusion. A person-centered model will be best solution here and all across the world. This is especially so, when we are fighting a disastrous pandemic.
| Plenary X: Rakesh Chadda (India) | | |
| Learnings from Ancient India: Relevance to Contemporary Psychiatry | | |
Rakesh K Chadda
Department of Psychiatry and Chief, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]
Abstract
India is one of the oldest civilizations of the world and has a rich cultural heritage. Ancient Indian scriptures (Vedas, Upanishads, and Gita) and epics (Ramayana and Mahabharata) which date back to 1–5000 years BCE are a great source of knowledge, principles of some of which have applicability to the discipline of psychiatry in contemporary scene. Similarly, Ayurveda, the Indian system of medicine with history going back to the Vedic period, has also recognized mental disorders, giving descriptions and explaining etiology and management. Bhagavad Gita has given detailed description of crisis management and dealing with anxiety, stress, and depression. Bhagawat Gita describes the principles of psychotherapy in a lucid way. Buddhism, one of the religions with origins in India, also describes principles of meditation and dealing with stress and anxiety. Yoga is another important gift of the ancient India and has been found to be effective in management of anxiety disorders. Yoga has also been an important role in mental health promotion, and management of a range of psychosomatic disorders. Many techniques of meditation have principles dating back to ancient India. Epics such as Ramayana and Mahabharata have important examples of dealing with stress or mental health issues which have relevance in the contemporary psychiatry. The methods of stress and crisis management, as described in the ancient Indian literature, have also applicability in dealing with some of the mental health issues during the COVID-19 pandemic.
| Invited Lectures | | |
| Engaging Communities for Mental Health | | |
David M Ndetei1,2, Victoria N Mutiso1, Christine W Musyimi1
1Africa Mental Health Research and Training Foundation, 2Department of Psychiatry, University of Nairobi, Nairobi, Kenya
E-mail: [email protected]
Abstract
Background: The mental health treatment gap in low- and middle-income countries (LMICs) is on average 80% compared to an average of 35% in high-income countries. This disparity can be accounted for by several factors found in LMICs. These include unresponsive health systems, poor human and financial resources, inadequate supply of many medications, stigma, poor awareness, inadequate legislative framework and misconceptions, and cultural beliefs surrounding mental illness. Objectives: To develop socioculturally and economically context-appropriate and sustainable innovations to significantly reduce the treatment gap and move toward mental health for all in Africa and other LMICs. Methods: Stakeholder engagement to develop the theory of change for community mental health. Results: Different categories of community stakeholders and human resources can be engaged through the process of participatory dialog to develop the theory of change for the development of community-based mental health services. The stakeholders are multiple and include: (1) mental health workers (psychiatrists counseling and clinical psychologists, nurses, and psychiatric social workers); (2) liaison practice: Integrating physical and mental health service systems. This loops in all other medical specialties and general practice for medical doctors; (3) informal (lay) mental health workers – Faith and traditional healers, community-based workers, recovering patients, and operating at the level of community-based service delivery systems and at the point of first contact; (4) other disciplines: Social scientists (for social determinants), health economists (cost-effectiveness of interventions and the impact of poverty), anthropologists (cultural determinants), communication specialists, and the media (for effective communication); (5) nongovernmental organizations, community-based organizations, human rights groups, and civil organizations; (6) communities and community leadership including administrative and key leadership, community gatekeepers, and community custodians of cultural values; (7) policymakers; (8) collaborations and researchers to generate data to inform policy and practice; and (9) people with lived experiences and their families. Conclusions: The treatment gap can be reduced by using the resources that we already have.
| Peace Ability and Coping with Aggression | | |
Maria Ammon
German Academy for Psychoanalysis, Germany
E-mail: [email protected]
Abstract
There are barely any articles in the literature of the recent years about peace ability itself. However, some authors deal with the prerequisites for peace ability which are altruism, and ethical attitudes such as guilt or forgiveness, to name a few of them. In addition, there are many different points of view on how peace ability and through that peace could be achieved. Further, it will be discussed how G. Ammon detached himself from the Freudian understanding of instincts and what his principle of social energy means for dynamic psychiatric psychotherapy and society itself. Finally, the paper reveals ideas how to prevent aggression and violence and what kind of new forms of solidarity must be developed.
| Online School Curriculum in the Era of COVID-19: A Boon or Bane? | | |
Basudeb Das
Central Institute of Psychiatry, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Background: The modern world has been passing through a most unprecedented situation in the form of the COVID-19 pandemic. This pandemic has forced the modern civilized world to witness a wide-scale stalemate in every aspect of civilization, and nobody is spared from its rage; indeed, COVID-19 has throttled every activity of human beings for more than 2 years. The Focus of the Talk: Activities that are thought to be the indispensable things for the existence of human beings are either controlled or cut down for controlling this lethal pandemic. Academic activities are dearly affected by this pandemic, and formal or routine academic activity like classroom teaching has to be replaced with online or virtual teaching modules. Nonetheless, this replacement has benefitted the student community up to a significant extent, but at the same time, it has also brought some psychological and behavioral problems which cannot be ignored. Students, especially school students, are embittered by the dual pain of online classes and missing the school environment. They do require professional support and care to overcome this stress. At the same time, their parents and family members are also required professional support from the mental health fraternity to overpower the crisis as well as learning the skill to address their children's emotional needs.
| Symposia | | |
| Could the Recovery of a Psychotic Patient Be Achieved without Psychoeducation Programs and without the Involvement of Families and Caregivers? | | |
Said Fattah, Yann Hodé, Mathew Varghese, Vincenzo Di Nicola, Hachem Tyal
Abstract
Considering the main theme of the Congress “Innovations in Social Psychiatry Across the World,” our symposium, which is organized by the World Association of Social Psychiatry Section of Family Intervention Programs, will address both themes proposed by the Congress: Psychosocial Interventions in Psychiatry and Mental Health Users and Caregivers and their role in improving the recovery of psychotic patients, especially with the COVID-19 pandemic tsunami:
| The Peer Health Mediator, a New Recovery-Oriented Paradigm | | |
Said Fattah1,2, Mihaela Tomsa2, Alexandra Mulller2, Fatah Senadla2
1WASP Section on Family Intervention Programs, 2Centre Hospitalier de Rouffach, Rouffach, France
E-mail: [email protected]/[email protected]/
[email protected]/[email protected]
Abstract
Mental health is now seeking to orient care more closely around the needs and objectives of the patient, which, from the point of view of the patient and the family, can sometimes be different from those identified by professionals. As a result, a new paradigm has been introduced in France since 2012, based on the concept of Peer Health Mediator, also called Peer Caregiver, by integrating this former patient, as a new agent into multidisciplinary mental health teams with a focus on recovery. I have had the pleasure and the opportunity to meet and work, since 2017, with one of these peer helpers during my work as a psychiatrist, hospital practitioner, and coordinator of a day hospital, in Mulhouse, a French city. In this presentation, I will develop the role of this Peer Health Mediator within our institution and what he brings with his experiential knowledge of the disease. I will specify the different areas in which he intervenes, once integrated as a full member of our team. In conclusion, this new management paradigm involving a former patient as a new agent of recovery could be a vector of hope, promoting empowerment in patients and their families with the consequence of better social and professional reintegration.
| Combination of Family Psychoeducation and Antipsychotic Treatment on Schizophrenia Suicidal Risk | | |
Yann Hodé1, Romain Padovani2, Marie Cecile Bralet3, Dominique Willard4, Said Fattah5
1Profamille French Speaking Network, 6 rue Lazare Weiller, Selestat, 2Le Centre de Santé Mentale et de Réhabilitation Psychosociale, 86 Bis rue Paul Herman, 97430 Le Tampon, La Réunion, 3EPSM Oise, Crisalid Department, 2 rue des finets, Clermont de l'Oise, 4Pôle PEPIT GHU Paris Psychiatrie et neurosciences 1, rue Cabanis PARI, 5Chairmann, WASP Section on Family Intervention Programs, Cabinet de Psychiatrie le Trident, 36 rue Paul Cézanne, Mulhouse, France
E-mail: [email protected]/[email protected]/[email protected]/[email protected]/[email protected]
Abstract
Background: About 5% of people with schizophrenia die by suicide. The psychoeducational program named Profamille version V3.2 reduces by a factor of 2 the number of patients who attempt suicide 1 year after the end of the first module of the program compared to 1 year before. Psychoeducational programs appear to improve compliance with treatment, and treatment may have a protective effect against suicide risk. Objective: We sought to verify whether in the Profamille program this reduction in suicidality was related to better compliance. Methods: The Profamille program is composed of an initial training module of 14 sessions on a weekly basis, followed by a consolidation module of 4 sessions over 2 years. Families were interviewed at baseline and 1 year later about the patient's opposition to treatment and insight and whether or not he had a long-acting antipsychotic. A good compliance is defined by good insight, no opposition to treatment and long-acting antipsychotic, and a bad compliance by the opposite. We focus our analysis on these two categories, excluding patients with intermediate compliance. Results: The number of patients belonging to the two categories was 208 at the beginning and 223 after 1 year. The odds ratio (OR) of the compliance improvement is 1.6. However, compliant patients did not have less suicide attempts before the program, and there were no suicide attempts neither before nor after the program among patients with poor initial compliance who would have good compliance 1 year later. On the other hand, the reduction was much more marked in compliant patients (OR = 5.7) than in noncompliant patients (OR = 1.7). Conclusion: If compliance is improved, this improvement does not necessarily explain the reduction in suicide attempts. To effectively prevent suicide in schizophrenia, antipsychotics alone may have a modest effect but can be boosted if family psychoeducation is associated.
| Canadian Innovations in Social Psychiatry: From Shared Care to Social Reconciliation | | |
Vincenzo Di Nicola, Manon Charbonneau, K Sonu Gaind, Constantin Tranulis, Eliot Sorel
E-mail: [email protected]
Abstract
This Canadian Association of Social Psychiatry (Symposium) highlights the Congress theme, showcasing Canadian social psychiatric innovations. The presentations span Canada's two largest provinces, Ontario and Quebec, addressing: complementary urban and rural, and community- and hospital-based practices; contrasting in-person versus telemedicine clinical care and teaching; and general psychiatric consultations with specialized interventions from shared care in child psychiatry to early intervention in psychosis. Across diverse practice contexts, we discuss disparities in the health and mental health care of marginalized populations, identifying an emerging consensus of intersectional health concerns and disparities, taking into account populational/patient parameters and practice settings for social reconciliation.
| Social Psychiatry and Digital Mental Health Care | | |
Abhinav Singh, Nand Kumar, Jitender Jakhar, Kanika Khandelwal
Department of Psychiatry, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
In the past 1½ years, the gap in accessibility to mental health care in conventional format has widened and simultaneously due to difficulty access to the treatment and the rise of issues pertaining to mental health. This gap has led to the advancements in digital health-care services with unprecedented demands in view of the current COVID-19 pandemic scenario. This situation has posed challenges to both the patients who need quality care and/or maintenance as well as the mental health professionals who have been facing the pressure to keep up with the rising numbers of individuals who have experienced either COVID-19-induced or COVID-19-mediated mental health issues. Technological solutions such as social media and telephonic IVRS-based helpline have mushroomed across the globe including India have been observing a huge inflow of requests probably due to lockdown-induced stress and anxiety to worsening of existing mental illnesses. One of the challenges with these is that these are not an effective alternative to physical clinics for reasons such as poor record maintenance, high attrition rate, poor follow-up, and sustainable and accessibility of the patient records. The existing digital health-care services are already overflowing with mainstream medical issues, and as a result, the issues related to mental health care are not being addressed optimally. We feel that we need effective intervention and solution to these challenges. We will be discussing the technological intervention with the help of our tele mental health program and existing challenges hosted by not for profit registered organization. The program “Mind Healthcare Online Program and Education” (MiHOPE) is intended for speeding up the outreach efforts in improving the accessibility of quality mental health-care services to masses at the comfort of their homes or nearest digital mental health-care facility in society. This program MiHOPE is offering its services since its 2020 and expects to further its reach by integrating rural sections of the society with nonexistent or negligible mental health care and introduce independent access to quality mental health care in near future.
| Should Tobacco Harm Reduction Approach Extend to Patients with Substance Dependence? | | |
Prabhoo Dayal, Om Sai Ramesh, Shiv Prasad Khader, Preethy Kathiresan, Gayatri Bhatia
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Although smoking cessation is currently the only guaranteed way to reduce the harm caused by tobacco smoking, another reasonable approach may be to try and reduce the harm from continued tobacco use among smokers unable or unwilling to quit. Possible approaches to reduce the exposure to toxins from smoking include reducing the amount of tobacco used, and using less toxic products. Commonly used harm reduction approaches for tobacco are potential reduced exposure tobacco products, electronic nicotine delivery systems, and smokeless tobacco alternatives like Swedish snus. This symposium aims to discuss theoretical background and evidence base for different tobacco harm reduction products along with their public health and policy aspects. The current global scenario of availability and acceptability of harm reduction measures along with recent advances will also be discussed.
| “I Could Find No Time to Shed my Tears” Understanding the Psychosocial Impact of COVID and Phenomena of COVID Grief | | |
Aniruddha Basu, Sukanto Sarkar, Ayoleena Roy
Department of Psychiatry, AIIMS, Kalyani, West Bengal, India
E-mail: [email protected]
Abstract
Introduction: Globally, as of July 30, 2021, there have been 196,553,009 confirmed cases of COVID-19, including 4,200,412 deaths, reported to the WHO. Hence, it is very important to highlight the short- and long-term psychosocial impact of COVID on those alive and those who have lost their near and dear ones to COVID:
The psychsocial impact of COVID involves immediate neuropsychiatric complications in the form of delirium, depression, or anxiety that are present in 25%–90%. Chronic sequalae include cognitive sequalae, fatigue, brain fog, depression, anxiety, mood symptoms, psychotic symptoms, and posttraumatic stress disorder. Several biological mechanisms have been proposed to link COVID-19 and such symptoms. Otherwise, research has also shown that the relationship between COVID-19 and mental illness is bidirectional. The indirect effects may be mediated by significant socioeconomic changes such as prolonged lockdown, financial problems, job loss, isolation, or prolonged stressful work for the “COVID warriors.” Much of evidence of the impact and psychosocial sequalae needs to be interpreted based upon the methodological rigor of the studies.
Grief has been traditionally understood based upon the theories proposed by Kubler Ross. However, the grief and bereavement related to COVID is unique as the bereaved individuals hardly had a chance to mourn – I could find no time to shed tears. To explain this uniqueness, dual-process model has been evoked by some authors. The presenter will try to give an update on the existing literature.
To understand COVID-related grief, a qualitative study is ongoing at the Department of Psychiatry, AIIMS, Kalyani, with approval of the Institute Ethics Committee. A semi-structured interview guide has been prepared from the review of literature and inputs of experts. With its help, at least 10 in-depth interviews will be conducted and thematic analysis will be done and an initial understanding will be presented.
| In the Spotlight: Sports, Exercise, and Mental Health for Social Psychiatrists | | |
Dhruv Shah, Frank Aguilar, T S Sathyanarayana Rao, Kristen Mazoki, Sivin Sam
University of Vermont Medical Center, Vermont, USA
E-mail: [email protected]
Abstract
The relationship of sports, exercise, and mental health is currently at the forefront of society and social media discussions. This year's Olympics has created an opportunity for social psychiatrists to review and discuss the evidence and their experiences around this critical relationship as it relates to the clinical care they provide to patients, families, and organizations. Prepandemic, the world was moving less than recommended which is leading to increased disease and mortality. The pandemic and recent events have highlighted the importance of getting outside and moving. The Olympic stage not only showcases global athletic competitors, but also this year, it has also carried a message for mental health. The speakers in this workshop hope to amplify the importance of social psychiatrists integrating exercise, wellness, and sports in their clinical work. Dr. Frank Aguilar, a sports psychiatrist, will share learnings from his experiences contracting with major US sports organizations like the National Football League. Dr. Rao will share his lifelong work around psychosexual health, embracing a discussion of sex as exercise. This will include covering biological, psychological, and social factors to consider while assessing sexual history and well-being with patients and families. Drs. Mazoki, Sam, and Shah will review some evidence and experiences as trainees and early career psychiatrists in their evolving clinical care. We aim to review the utilization of technology and wearables in tracking activity and improving functioning both in sports and exercise. This data set can also translate to mental health and social functioning for patients. We will also review an approach to integrating sports, exercise, and wellness review with families while caring for children and adolescents referred for psychiatric assessment and care in the US and compare this to the general psychiatry resident trainee experience in India. At the end of this symposium, we hope that social psychiatrists can continue to gain knowledge in the growing body of evidence and experiences in the world of sports and exercise, and its relationship to mental health. We hope to provide some tools and considerations for social psychiatrists in their clinical work and inspire questions for further research and collaboration.
| A Study of Psychosocial Aspect and Substance Abuse in Sadhus and Psychosocial Aspects of Beggars in Indore District | | |
Ram Ghulam, Surya Pratap Singh, Suvaran Sagar Bajpai
Malwanchal University, Indore, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Sadhus are called Yogi, Saint, Bairagi, and Sanyasi. They do not have any personal properties, houses, family, and family names. They are not allowed to follow particular religion and are not permitted to stay in a fixed center. Therefore, they move here and there and beg for his daily food. Sadhus are not allowed to store food and property for the future. They do not have any willing and ambitions for the future life. They move wherever they want and eat whatever they get. It is believed that they become sadhu to escape from the household difficulties. In the same way, it is said that some people cannot accept the changing environment of the society and become a sadhu. Infarct they are beggars and unproductive people and burden on society. A large number of sadhus are addicted with cannabis which is socially accepted. Whether cannabis is a factor for adopting this lifestyle, it is questionable? We have studied 100 sadhus in our Indore district – etiology and their psychosocial aspects and addiction, particularly to cannabis. The results will be presented in the symposia. Begging is one of the most endemic multifaceted social problems with great magnitude, but it is less understood in all its dimensions. The phenomenon of begging is a result of a number of factors, such as poverty, physical disability, culture, frustration, unwillingness to work, tendency toward social isolation, “it is not a crime” tendency, tendency to quick income, mental illness, inherent attitude toward begging, religious superstition, and religious misinterpretation. The thorough knowledge of causes of begging is essential for framing national policies to uproot the menace of begging from the society. Begging is the practice of imploring others to grant a favor, often a gift of money, with little or no expectation of reciprocation. We have studied the psychosocial aspect of about 200 beggars in the Indore district and will present at symposia.
| Telepsychiatry Expanding Access to All in COVID Era: Promises Kept and Challenges Upheld | | |
Shruti Srivastava, Manjeet S Bhatia, Dinesh Kataria, R C Jiloha
Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
E-mail: [email protected]
Abstract
Background: Sudden outbreak of pandemic urged regulatory authorities to open doors of statutory valid but sudden implementation of telemedicine guidelines in India. It held promises to expand care access to persons in remote part of country as well those stuck inside houses or isolation facilities due to COVID-appropriate protocols. It tried to embark a horizon where basic service delivery could meet COVID safe behavior. In this symposium, we would like to present the service delivery experience of extending this access to different sectors of society and challenges in the context of developing countries. Objectives: (1) Social implications of the teleconsultation services at various levels – college students, patients suffering from mental illnesses, health-care workers, and COVID-positive patients, and (2) challenges encountered in the delivery of health-care services via telemedicine. Methodology:
1. Telepsychiatry services for college students: Dr. Shruti Shrivastava, Professor, Department of Psychiatry, University College of Medical Sciences
Pandemic affected college students with not only stagnant academics rather loss of family members and unexpected loss. Spectrum of mental health problems ranging from fear of catching the virus, anxiety attacks, grief, suicidal ideation, acute stress reactions, adjustment problems, to full-blown mental disorders such as depressive disorder, obsessive–compulsive disorder, exacerbation of prior mental health conditions, et cetera were dealt.
2. Telepsychiatry services for COVID patients in a COVID-designated Guru Teg Bahadur Hospital, tertiary care: Dr. MS Bhatia, Director Professor and Head, Department of Psychiatry
The period of isolation as part of COVID-19 management protocol was marked by stress, anxiety, emotional turmoil, suicide risk, delirium, and encephalopathy. Detection of neuropsychiatric manifestations in patients suffering from COVID-19 involved thorough psychiatric evaluation, rating scales, relevant investigations. Appropriate interventions on case to case basis were provided.
3. Telepsychiatry services for health-care workers (HCWs): Dr. Dinesh Kataria, Director Professor and Head, Department of Psychiatry, Lady Hardinge Medical College
Health-care workers experienced significant psychological distress working in the forefront of COVID care services due to lack of personal protective equipment, excessive workload, and risk of infection to self and family members.
4. Challenges for psychiatry outpatient services in virtual platform: Dr. R. C. Jiloha, Senior Emeritus Professor, AIIMS, Rishikesh
Sudden imposed shift to a virtual platform offered several benefits of COVID safety but posed challenges in forming rapport, holistic evaluation, side effect ascertainment, and privacy. Results: Telemedicine guidelines passed by the Government of India in March 2020 helped services to reach throughout the length and breadth of the country. Necessary training of health-care workers for effective delivery of telehealth services was a big challenge. Network issues, lack of technology, and lack of awareness at the various levels of the population were the biggest hurdles. The services however rendered continuity which was otherwise going to be disrupted due to lockdowns imposed. Conclusions: Telemedicine services need to be developed in parallel to the other health-care systems as they can bring out the reach of tertiary care services to the common man avoiding exposure to deadly virus at low cost.
| The Levers of Despair: Global Perspectives on Suicide during COVID Pandemic | | |
Raman Marwaha1,2, Dhanalakshmi Ramasamy3, Smitha Ramadas4, K Sonu Gaind5
1Residency Program Training Director, Case Western Reserve University, 2MetroHealth Medical Center, Cleveland, Ohio, US, 3Medical Director, Department Lehigh Valley Physician Group, Psychiatry, Institute/Hospital, Lehigh Valley Health Network, Allentown, PA, USA, 4Additional Professor, Department of Psychiatry, Government Medical College, Thrissur 680596, Kerala, India, 5Chief of Psychiatry/Medical Director of Mental Health, Humber River Hospital, Co-Director, Adult Psychiatry Health Systems Division, University of Toronto Department of Psychiatry, Governor and Associate Professor, University of Toronto, Canada
E-mail: [email protected]
Abstract
The suicide rate in the world in 2019 was 9 per 100,000 per WHO. While there are conflicting reports that COVID-19 pandemic has led to increase or decrease in suicide rates, we are just getting to know the short- and long-term mental health effects of the pandemic. While suicide rates vary across the world, common themes emerge when examining disproportionately high suicide rates in marginalized and indigenous populations. Through this symposium, panelists will be discussing global perspectives on suicide during a pandemic. Dr. Ramasamy will discuss the epidemiology of suicide and high-risk populations. Dr. Gaind will discuss that while suicide is often thought of as a mental health issue, the common themes leading to despair and wishes to die in these situations are often more related to social issues than to individual health or mental illness. This session will examine the importance of understanding and addressing these issues, especially as many jurisdictions liberalize health policies to allow individuals to seek state-facilitated death through physician-assisted dying pathways. Dr. Marwaha will discuss perspectives regarding a high-risk subset of population – physicians – there are 300 physicians who die by suicide in the U. S. per year. Even before the pandemic, burnout and moral injury has been prevalent among clinicians. The pandemic has increased and added new challenges for physicians and trainees. Audience will learn about approaches to help this group of people. Dr. Ramadas will discuss how do we go about suicide prevention in the context of a pandemic. The factors which can help to prevent suicide such as maintaining social connectedness, financial security, spreading timely awareness and information, drive for vaccination, prevention, and management of psychiatric morbidity, responsible media reporting of suicide, and pandemic-related information will be discussed.
| Perinatal Mental Health Service Delivery Models: Reflections from South Asia | | |
Prerna Kukreti, R Pracheth, Ramdas S Ransing, Chonnakarn Jatchavala
Lady Harding Medical College, Delhi, India
E-mail: [email protected]
Abstract
Perinatal mental health has a significant impact on maternal and neonatal morbidity as well as mortality. However, in Asian countries, it is still practiced as isolated models of care than being woven in routine obstetric and neonatal health. This symposium presents magnitude of perinatal mental health problems and innovative solutions to address in South Asian perspective.
Perinatal mental health problems: Burden and public health approaches from South Asia: Dr. Pracheth, Associate Professor Community Medicine, Yenepoya Medical College, Mangalore, India
This section will discuss the magnitude of different perinatal mental health problems and concerned existing health programs, policies, and health infrastructure in different South Asian countries.
Integrated maternal mental health service: Innovative models across South Asia: Dr. Prerna Kukreti, Associate Professor Psychiatry, Lady Hardinge Medical College, Delhi, India
Despite huge burden of maternal mental health morbidity, service implementation still remains a challenge. This section will focus on innovative models developed by various South Asian countries ranging from screening programs to intervention programs.
Brief Intervention for Depression in Pregnancy (BIND-P), a stepped care model for perinatal depression: Indian experience: Dr. Ramdas, Associate Professor Psychiatry, B. K. L. Walawalkar Rural Medical College, Ratnagiri, India
This section will focus on BIND-P developed in India as a stepped-up care model for implementation in the National Mental Health Program. It is a unique model for screening, referral, and intervention of perinatal depression by nonspecialized health-care workers.
Perinatal mental health during COVID: Reflections from Thailand: Dr. Chonnakarn Jatchavala Assistant Professor Psychiatry, Prince of Songkla University, Thailand
This section will focus on impact of COVID pandemic on perinatal mental health care in Thailand and implementation of “Riseup-PPD-COVID-19,” World Health Organization's protocol on mental health care in pregnancy.
| Psychosocial Factors Contributing to Pregnancy-Specific Anxiety: Implication for Intervention | | |
Pratibha Gehlawat, Tanu Gupta, Charu Sharma
AIIMS, Jodhpur, Rajasthan, India
E-mail: [email protected]
Abstract
Background: Pregnancy brings both physical and psychological changes in a woman. Due to anticipated uncertainty associated with pregnancy, it may give rise to stress and anxiety. A diverse prevalence rate of 14%–54% of pregnancy anxiety has been reported worldwide. This not only affects pregnant women's health but also has negative impact on labor outcomes, i.e., preterm delivery and low birth weight. Pregnancy-specific anxiety (PSA) is defined as worries, concerns, and fears about pregnancy, childbirth, and health of infant and future parenting. Existing research postulates that PSAs are the real predictors of adverse labor outcomes rather than general anxiety. Therefore, early identification and management of PSA becomes more important to reduce the negative impact on pregnancy outcomes in a more specific manner. However, in low- and middle-income countries, the measures to address and explore anxiety during pregnancy are buried under heavy patient load, lack of workforce, and adequate resources. Furthermore, the psychosocial factors such as social support, abuse, violence, unwanted or planned pregnancy, patriarchy, familial relationships, roles and responsibilities of a woman, and giving birth to female child can be considered to be contributing factors to PSA, especially in Indian subcontinent. Thus, a comprehensive understanding of PSA and associated psychosocial determinants is need of hour to guide for treatment and psychosocial interventions that may ultimately lead to better maternal and fetal outcomes. Objectives: Speaker 1 will cover PSA, how it is different from general anxiety during antenatal period, impact on maternal and fetal outcomes. Speaker 2 will discuss the assessment of PSA, different measures and scales available to assess PSA, and psychosocial factors contributing to PSA. Speaker 3 will discuss the designing and implementation of appropriate strategies to properly manage and address PSA based on the psychosocial factors.
| Women at Risk Refugees, Refugee Mothers, and Their Resettlement | | |
Rama Rao Gogineni, Wolfgang Rutz, Suzan Song, Nouf Bazaz, Marianne Kastrup, Vincenzo Di Nicola
Cooper Medical School of Rowan University, Camden, New Jersey, USA
E-mail: [email protected]
Abstract
Women represent almost half of the 244 million migrants and half of the 19.6 million refugees worldwide, an increase by 41%. Refugee and migrant women and marginalized women face specific challenges and protection risks. Dr. Rutz: Refugee women face challenges in transit, including family separation, psychosocial stress and trauma, health complications, particularly for pregnant women, physical harm and injury, and risks of exploitation and gender-based violence, caring for children and elderly. Sixty percent of preventable maternal deaths take place in humanitarian settings, and at least 1 in 5 refugees or displaced women are estimated to have experienced sexual violence and structural oppressions. Many reported high levels of traumatization, posttraumatic stress disorder, anxiety, depression, and somatization. Dr. Song and Bazaz: More than half of Syria's population has been forcibly displaced with Syrian refugees comprising nearly 30% of all refugees, Refugee Mothers Project in Baltimore Area of US found that Syrian refugee women, pregnancy and early parenting during resettlement was exacerbated by emotional distress, somatic symptoms, and a lack of social support. Interviews suggested potential cultural idioms of distress and marked changes in support systems postresettlement. Studies sponsored by IMC/UNICEF in Syrian refugee camps in Jordan found challenges with parenting including family violence, fear of sexual violence, management of unaccompanied/separated children, caring for children and women with disabilities, child labor, early marriage, and bullying/discrimination. Dr. Kastrup: Marginalized populations comprise ethnic and racial groups, women, LGBTQ, indigenous populations, children and adolescents, and homeless and prison populations. Barriers to achieve full access to health care comprise, for example, lack of economic resources, discrimination, restrictive policies, or culturally unacceptability. Many ways may be taken to overcome the current situation and reduce the marginalization. Dr. Di Nicola and Dr. Gogineni – Discussants: Addressing refugees and migrants needs a more humane and coordinated approach that should include achieving gender equality, the empowerment of all women and girls.
| Effects of COVID-19 Pandemic on People with Neurodevelopmental Disorders and their Carers | | |
Rama Rao Gogineni, Anthony Rostain, Ayesha Mian, Varghese Punnoose, Karim Sedky
Cooper Medical School of Rowan University, Camden, New Jersey, USA
E-mail: [email protected]
Abstract
The pandemic has the potential to worsen neurodevelopmental disorders attention deficit hyperactivity disorder, autism spectrum disorder, and consequences of intellectual and developmental disability (IDD) with an increase in MH, psychosocial consequences in children and parents. Dr. Rostain: Many of the neurodevelopmental disorders are illnesses of life span and require multiple supportive, life-enhancing interventions. COVID pandemic increased fear phobias, anxiety clinginess, distraction, irritability, anxiety, depression, mood lability, impaired social interaction, sleep disturbances, low self-esteem, substance use disorder, and suicide. Dr. Gogineni: Parents and caregivers are currently experiencing much turmoil. They are increasingly burdened by the changing nature of caring for their children and other family members. This may cause caregivers to experience intense distress, anxiety, depression, and social withdrawal. Parents are finding themselves simultaneously expected to play the role of parent, special education teacher, and individual aide, all the while having to provide care for other children in the home and juggle work from home. Dr. Mian: In Pakistan's 28 million persons with disabilities, parents of children with IDDs are facing various challenges including financial constraints, social lockdown, and deteriorated health conditions of their children, reduced or no health services, closure of educational institutes, negative behavioral impacts, and slow mental development. Dr. Punnoose: In India, people with an intellectual disability and their careers faced higher rates of mortality; more severe health outcomes; reduction in the availability and access to face-to-face services; and risk of increased mental illness, such as loneliness, agitation, anxiety, distress, and increased challenging behavior. There is evidence that there is a higher risk for those residing in residential group homes. Dr. Sedky: Individuals with IDDs experience sleep problems at higher rates. Overall, sleep problems are common and treatable in individuals with IDD.
| Mental Health-Care Delivery in Patients with COVID-19 | | |
Suyog Jaiswal, Sreelakshmi Vaidyanathan, Sonakshi Jyrwa, Jyoti Singh Latwal
AIIMS, Nagpur, Maharashtra, India
E-mail: [email protected]
Abstract
The COVID-19 pandemic has stretched the health-care system to its limits, largely remaining a puzzle with no definitive treatment and ever-emerging variants. The overwhelming psychological stress on such patients (observed devastation, concerns about deterioration, physical isolation, and social discriminations) and the central nervous system effects of SARS-CoV-2 infection together may lead to various psychiatric symptoms such as insomnia, depressive mood, anxiety, aggressive outbursts, and even suicidal ideations. Literature suggests that up to 35% have depressive symptoms, 28% have anxiety, and 20% may have impaired consciousness and confusion which is linked with severe progression of disease. Persons with mental illnesses are at a higher risk of contracting viral infections because of a myriad of factors, such as a chronically dysregulated innate immune system, cognitive and higher motor functioning, and sometimes deficient personal hygiene. The recommendations and necessary social isolation can limit the continuation of tailored care, support, and treatment for these patients. The situation worsens when these patients develop COVID-19 and require hospitalization for management, away from familiar caregivers, and receive care through the barriers of personal protective equipment. All patients admitted at our hospital were screened for need of mental health care telephonically and received counseling, with in-person consultation provided as required on a case-to-case basis for further management. The experience sharing of COVID-19 recovered health-care professionals via audio announcement system was initiated to boost the morale of patients. All the patients were managed within COVID-19 isolation protocols. The current evidence, unique experience, novel approach at screening and support, learnings, and future directions for mental health-care delivery in a dedicated COVID-19 hospital (DCH) will be discussed.
| Community and Preventive Psychiatric Services: An Initiative to Combat COVID-19 Impact on Mental Health | | |
Puroshottam Jangid, Vinay Kumar, Priti Singh, Sunila
Pt BD Sharma, PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
COVID-19 emerged as a global pandemic and lockdown was announced in India on March 24 preceded by a voluntary janta curfew. The lockdown was extended twice followed by stepped unlock and again a second lockdown during the second wave. This whole period created havoc for patients with mental health problems, mental health services at various levels, teaching and training, and mental health of the mental health professionals. Right from the consultations to the patients in prelockdown phase with all the COVID protocol to attending to the need of the patients and community later on posed a great challenge. A multidisciplinary team of CAPPS was constituted at Institute of Mental Health to look into the mental health services in background of these issues as well as to provide services in accordance with the Chapter VI of MHCA-17. The initial activities of the team were focused on helping the patients to follow COVID-appropriate behaviors. Follow-up patients were reviewed and attended by informal telephonic suggestions. As traditional community activities were not possible, team focused on public education through print and broadcast media. Various days of importance in context of health and well-being were used as opportunities for public education and awareness days. Team stayed in constant touch with newly developed telepsychiatry services in the department and patients were motivated to utilize this for follow-up consultations. Focused activities for stress management were done for students of various groups. The preventive importance of diet and lifestyle modification was continuously discussed with various groups. Caregivers and patients were attended through small group sessions to let them understand more about their health and illness. We will focus on post-COVID mental health issues in patients and general population. We plan to educate the patients and caregivers regarding the human rights and the provisions of MHCA-17 so that they feel more empowered. Domestic violence will also be focused. Continuous efforts will be taken in areas of stress management. After the situation is normalized, we plan to move in community in a more assertive way organizing mental health and de-addiction camps and community outreach programs.
| Psychiatric Rehabilitation in India: Progress and Challenges | | |
Bhupendra Singh, Hitesh Khurana, Poonam Gupta
Institute of Mental Health, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Interventions that focus directly on functional impairments related to mental illnesses constitute psychiatric rehabilitation. Rehabilitation is a comprehensive and multidisciplinary approach. Due to limited mental health facilities in India, psychiatric rehabilitation is still an unfulfilled dream. Through this symposium, we intend to focus upon need, method, and future of psychiatric rehabilitation in India. Mental disorders and disability: The Indian scenario (Hitesh Khurana, MD): People are still not adequately aware of symptoms of mental disorders and treatment facilities available leading to large treatment gap. The government has drafted mental health policy in 2014 emphasizing preventing stigma and integrating people with mental disorders in the mainstream. This particular part of symposium covers the epidemiological aspects related to burden of mental disorders pre and post 2014 to see the impact of national mental health policy. Psychiatric disability and role of social work (Bhupendra Singh, PhD): Psychiatric rehabilitation in India is in a dynamic phase of growth and can best be considered in three different sectors, namely hospital-based initiatives, initiatives by nongovernmental organizations, and consumer initiatives. Unfortunately, in India, majority of patients still do not have access to any form of psychosocial intervention, let alone a well-integrated psychiatric rehabilitation service. This part is a brief overview of the services and concerns related to psychiatric rehabilitation in India. Role of Clinical Psychologist in Rehabilitation (Poonam Gupta, PhD): The vision of psychological rehabilitation is to enable individuals with mental disabilities to recover and to live as normally as possible in the community. It also helps in reduction of impairment and remediation of disability through skill training and optimization of resources to enhance their capacities. The process includes reduction of impairment, remediation of disabilities through specific life skill training, therapeutic interventions, and empowering them toward independent living in the community and strengthening them. This part will cover the psychological management.
| Avenues for Growth of Addiction Psychiatry in India: Recent Initiatives and Advances | | |
Atul Ambekar, Prabhat Kumar Chand, Ravindra Rao, Alok Agrawal, Roshan Bhad
Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Addiction psychiatry needs to grow in India considering the huge magnitude of substance use disorders and the wide treatment gap. This requires enhanced institutional mechanisms for treatment through health system strengthening as well as capacity building of health personnel. “The landscape of Addictions in India and the genesis of APSI” (Speaker: Atul Ambekar): Though professional societies in mental health/psychiatry do address addictions, an exclusive addiction professionals' forum was needed. Hence, “Addiction Psychiatry Society of India (APSI),” a promising start, requiring enthusiastic participation from the professional fraternity. “Building Communities of Practice (CoP) in Addiction management” (Speaker: Prabhat Kumar Chand): Information-technology tools can be effectively used to train health-care personnel in addiction treatment. More relevant in the current pandemic times when conventional teaching-learning is giving way to technological solutions. The “Virtual Knowledge Network (VKN),” NIMHANS trains physicians as “addiction management champions” using case-based learning, collaborative care, and telementoring. “Developing Online Training Program (OTP) for Addiction Treatment” (Speaker: Ravindra Rao): The Online Training Program (OTP) developed by NDDTC AIIMS hosted on https://naat.co.in/offer the unique feature of being accessible anywhere, anytime, as per the desired pace and convenience. The leaner interacts only with the computer-screen, minimizing the need for two or more individuals interacting simultaneously. “Enhancing avenues for addiction treatment in government hospitals” (Speaker: Alok Agrawal): Advocacy for bridging the treatment gap has resulted in the Government of India initiating two schemes being implemented by NDDTC AIIMS – the Drug Treatment Clinic (DTC) Scheme (MOH&FW) and the Addiction Treatment Facility (ATF) Scheme (MOSJE) – under which multiple hospitals are financially supported for human resources, capacity building, and supplies including medicines. “New Professionals Exploration Training and Education Committee of International Society of Addiction Medicine – ISAM NExT” (Speaker: Roshan Bhad): ISAM NExT is aimed at mentoring early career addiction treatment professionals in research, training, clinical practice as well as career progression at the global level, offering an opportunity for international exposure to all the younger addiction psychiatrists in India.
| Smokeless Tobacco Use and Health Risks: An Update | | |
Sonali Jhanjee, Raka Jain, Kamini Verma
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Smokeless tobacco (SLT) contributes to global burden of disease, disability, and death, with the highest burden on India and the Southeast Asia region. It accounts for over one-third of all tobacco consumed in India. Research studies have shown linkage of SLT use with oral potentially malignant disorders and cancers of oral cavity, esophagus, and pancreas along with possible contributory role in cardiovascular disease, hypertension, peptic ulcer, and fetal morbidity and mortality. SLT products are known to contain more than thirty carcinogens, for example, tobacco-specific nitrosamines (TSNAs), nitrite, nitrate, and heavy metals such as nickel, cadmium, and chromium. The most harmful chemicals are TSNAs, which form during the growing, curing, fermenting, and aging of tobacco and are considered a potent class of carcinogens. The most prevalent TSNAs are as follows: N′-nitrosonornicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, N′-nitrosoanabasine, and N′-nitrosoanatabine. Nicotine along with other tobacco alkaloids and constituents is the addictive substance that drives the continuing use of these products. The focus of the presentation would be to discuss various health risk associated with SLT use with special focus on the malignancies associated and different methodologies for the determination of TSNAs and other factors such as basic pH level, moisture, and the nitrite/nitrate content of the product in the common SLT products. Using SLT can cause serious health problems, still there is a wide gap in existing SLT control policies and their enforcement due to lack of research, training, capacity, and adequate resources.
| Psychosocially Informed Approach to Comorbid Severe Mental Illnesses and Substance Use Disorders | | |
Siddharth Sarkar, Balaji Bharadwaj, Abhishek Ghosh, Arpit Parmar
Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Dual diagnosis, i.e., comorbidity of substance use disorders and other psychiatric disorders, is a common occurrence in the clinical setting. The presence of comorbidity makes the presentation complicated, makes the management challenging, and worsens the prognosis of the patients. Since there are many types of psychiatric illnesses and substance use disorders, comorbidities may be present in patients in various combinations. The combination of the psychiatric illness and the substance use disorder determines the unique facets that would be affected and the different features of the patient that needs to be taken cognizance of. The substance use disorder comorbidities in severe mental illnesses merit due attention to improve the overall process of care. Severe social factors determine the occurrence of comorbid conditions, and play a role in the management of the patient. This symposium discusses a psychosocially informed approach to patients with dual diagnosis of severe mental illnesses and substance use disorders. The first speaker would discuss psychosocial factors that have a role in the etiology of the comorbid severe mental illness and substance use disorder. The second speaker would discuss how the social factors may affect the presentation and help seeking for such patients. The third speaker would discuss the psychosocial interventions that may are likely to work for patients with substance use disorders and severe mental illnesses. The fourth speaker would discuss the policy aspects, ethical and legal issues, and research issues for patients with comorbid severe mental illnesses and substance use disorder.
Keywords: Comorbidity, dual diagnosis, schizophrenia, severe mental illness
| Kerala Model for COVID | | |
Varghese P Punnoose, Varghese Punnoose, Sairu Philip, Merin Poulose, G Sruthy, Sneha Susan Varghese
E-mail: [email protected]
Abstract
The first case of COVID-19 infection in India was reported from Kerala in January 2020. The health-care system in Kerala swung into action and could contain the first wave of the pandemic very effectively by invoking public health principles and social measures. The death rate was one of the lowest in the world. Community participation was richly evident in psychosocial interventions. However, this excellent track record could not be maintained in the second wave because of several reasons. The pandemic experience in Kerala brought to foreground several mental health issues such as substance use, Internet addiction among youth, domestic violence, and suicide. The role of mental health is increasingly being recognized in COVID care. The natural experiment of COVID pandemic evolved practice and training of psychiatry in Kerala, a state with unique demographic and health characteristics. These changes could be predictors for changes in waiting for the rest of India and perhaps for the rest of the developing world.
| Emergence of Digital Mental Health: Is the Future of Tomorrow? | | |
Aseem Mehra, Krishan Kumar, Thiyam Kiran Singh, Ajay Kumar
Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
E-mail: [email protected]
Abstract
After the COVID-19 pandemic, treatment for psychiatric problems started to undergo a fundamental change. This change is driven by the need and emergence of “digital technology” such as mobile software apps and web-based apps. There are well-established digital treatments for disorders such as depression and anxiety, but the problem is that it varies in their content, format, clinical range, mode of delivery, and functionality. Content wise, most of them are based on existing cognitive behavior therapy, face-face therapy, or self-help guide. The major limitation is that most of them used behavioral procedures rather than cognitive components. True novel, patient's feasible treatments are very few and far between. Most of the available treatments are disorders specific; there is a lack of symptoms or person-specific like for suicidal thoughts. The format of the digital monitoring or symptoms or assessment of treatment varies from app to app. Digital technologies are rigid, and cannot be modified or flexible according to a person's demographic or cultural background. In recent times, digital platforms include features such as learning exercises, self-monitoring tools, downloadable videos, audio or documents, animated movies, quizzes, games, and progress reports with audio and video feedback. Examples of multifaceted and technologically sophisticated interventions are recent ones for social anxiety disorder. Digital technology provides new means of assessing and monitoring of psychopathology. Digital technology made the administration, interpretation of the assessment questionnaire easy prior to digitalization of assessment, which has been primarily done in pencil-and-paper format and manually scored. Majority of the validated tools are readily available in digital platforms and can be completed via an app or a website. This helps the investigators to get automatic scores and interpret with reference to establishing norms. In many of the apps, the scores and interpretation of findings can be transmitted directly to clinician, the user, and the user's clinical record. The psychometric properties are a matter of concern. From the recent experience, it can be said that digital mental health technologies will gradually find their place within mental health-care systems, and online clinics will become more commonplace.
| Preventive Psychiatry: Tertiary Prevention and Psychiatric Rehabilitation | | |
Uttam C. Garg, Roy Abraham Kallivayalil, Adarsh Tripathi
E-mail: [email protected]
Abstract
Preventive medicine can be divided into primordial, primary, secondary, and tertiary. While primordial deals with health promotion, primary prevention aims to prevent disease occurrence in people with risk factors, secondary prevention strives for early diagnosis and treatment, and tertiary aims to limit the handicap and disability from the disorders. While the preventive paradigm had been traditionally ignored in psychiatric practice, it has started to receive some amount of attention from clinicians, researchers, and policymakers alike, which is an encouraging development. Many evidence-based strategies have been developed and tested in different population and resource settings. While primary and secondary prevention strategies require a concerted effort by the health professionals, health regulatory bodies, and governments and are resource-intensive endeavors, strategies of tertiary prevention, i.e., limiting disability and rehabilitation, are something that each and every practitioner can and should be aware about and following on a regular basis. It is not possible to overstate the impact and the difference it makes to the life of an individual suffering from a psychiatric disorder and the amount of professional goodwill and satisfaction it can fetch for the practitioner.
| Co-Producing Mental Health Literacy in Communities in India Using Applied Theater Methodology | | |
Nadia Svirydzenka, Raghu Raghavan, Andy Barrett, Michael Wilson, Chandradasan
Mary Seacole Research Centre (Mental Health, Culture and Diversity), Leicester, England, UK
E-mail: [email protected]
Abstract
Despite the psychiatric pluralism found in India, stigma about mental illness is still widespread in the South Indian state of Kerala. Therefore, people with mental ill-health can internalize public perceptions and become resistant to approach mental health facilities. Mental health interventions embedded in local cultural, economic, and social contexts are needed. Thus, we used a novel theatrical methodology, to explore and develop culturally appropriate and acceptable mental health literacy narratives in Kerala in both rural and urban communities. This interdisciplinary research adopted a participatory approach to engage and empower communities through co-production and co-creation of culturally appropriate knowledge and practice. The translation of research findings into theatrical pieces was a collaborative process that took place in different stages: (i) community mapping and rapport building, (ii) collection of narrative interviews of mental health service users and carers, (iii) relaying and staging of their personal narratives through thematic breakdown (researchers and theater team), and (iv) scripting site-specific theatrical pieces tailored to unique psychosocial needs and culturally congruent with urban/rural, religion contexts. Resulting eight distinct participatory performances were analyzed through observation, discussion, and postperformance feedback and impact. Plays had a considerable degree of engagement from participants within the different communities. There was a feeling of solidarity between the performers and the audience and a common affinity for regional music and dance. This inclusive methodology created a space and opportunity to discuss mental ill-health and mental health literacy narratives based on their cultural norms. Performances and discussions involved cultural and religious practices, urban and rural conceptualizations of mental illness, and societal attitudes. The consensus was the need for reform in attitudes toward mental health and illness. Performances aided in community building by eliciting the existing notions of mental health and throwing light on the isolation and stigmatization attached to mental illness.
| Tribal Narratives of Users, Carers, and Community Members on Mental Health Literacy from Attappadi, Kerala | | |
Aarcha Varma, Raghu Raghavan, Ardra Raghu, Chitra Venkateswaran, Sreedevi Ramkamal
Mental Health Care and Research Foundation (MeHac), Kochi, Kerala, India
E-mail: [email protected]
Abstract
Good mental health is recognized as an integral part of a person's well-being and development embedded in all aspects of life, their beliefs, faith, culture, environment, spirituality, work, housing, education, and family and community respect. The attitudes and behavior concerning mental ill-health often differ markedly in low- and middle-income countries from those in high-income countries, and mental health literacy (MHL) is proposed as a means of enhancing tolerance, self-care, care for others, and to reduce stigma. Cultural beliefs affect MHL and hence it is vital that MHL programs are embedded in the lived experiences from local culture and societies. Our research explored how best to promote the socially and culturally appropriate MHL using participatory approaches across four Kerala districts. In this paper, we explore the tribal narratives of users, family carers, and community members from the tribal population of Attappadi. Narrative data were collected from service users, family carers, and community members (n = 16). We recruited a gender-balanced sample representative equally of young people, adults, and the elderly. All interviews were conducted in Malayalam/Tamil and translated to English. Using a combination of open-ended and structured questions, we will explore participants' knowledge and awareness of MHL. Gathered narratives reflect users' experience of their journey through mental health services, the attitudes of their families, friends, employers, and their immediate community and social network contacts as well as carer and community attitudes toward people with mental ill-health. Individual narratives also highlight the vital role of spirituality in healing practice (negative and positive) and conceptualization of mental illness in general. For success, future interventions need to accommodate and integrate services in line with spiritual and cultural views on mental health.
| The Influence of Religion and Spirituality on the Mental Health Literacy of Muslim Service Users, Caregivers, and Community Members in Malappuram, Kerala | | |
Sanjana Ravikumar, Raghu Raghavan, Ameer Ali, Manoj Kumar, Saliah Hussain
Research Fellow, Project MeHeLP, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Malappuram is a district in Kerala with a higher percentage of Muslim population. A large proportion of individuals from this district live below the poverty line resulting in several social and economic challenges which can have an adverse impact on mental health. Muslims from this district may hold specific beliefs integral to their faith which may influence their perception toward mental illness and may help or hinder their pathway to care. This paper explores the perceptions of mental illness among Muslim service users, caregivers, and members of the community in Malappuram, Kerala. A qualitative approach using semi-structured interviews was conducted with mental health service users, caregivers, and community members in Malappuram, Kerala. The interviews focused on several factors to deduce individual attitudes toward mental illness, including the etiology of illness, course, significant life events, the role of religion and spirituality, explanations for abnormal behavior, experiences with treatment, and activities that aided in helping with mental illnesses. Our study found several insights into the relationship between Islam and mental health. To a considerable extent, religious beliefs influenced the perceptions of Muslims toward mental health. Models of help seeking were also discussed among the Muslim community, several of which were specific to Islamic faith and acted as coping mechanisms. The understanding of mental illness from an Islamic perspective does not necessarily rely on or fit with the traditional Western medical model. The lens by which Muslims understand their religious beliefs cannot be ignored as they influence all facets of individual perceptions including their outlook toward mental illness, care, and treatment. Cultural explanations were also intertwined with individuals' religious beliefs and hence understanding religious beliefs within a psychosocial context can help in the development of a holistic approach which may boost mental health literacy and improve access to care.
| Multiple Mental Health Literacies in a Traditional Temple Site in Kerala: The Intersection between Beliefs and Spiritual and Healing Regimes | | |
Brian Brown, Raghu Raghavan, Aarcha Varma, Chitra Venkateswaran, Amanda Wilson, Uma Parameswaran
De Montfort University, Leicester, United Kingdom
E-mail: [email protected]
Abstract
The notion of mental health literacy has been proposed as a way of improving mental health problem recognition, service utilization, and reducing stigma. Yet, the idea embodies a number of medical model assumptions which are often at odds with communities' spiritual traditions and local belief systems. This is a study of mental health service users, carers and community members in a temple town in Kerala, South India. This paper will consider the relationship between religious beliefs, locally nuanced understandings of the human condition, and contemporary medical and psychotherapeutic formulations of mental ill-health. We will thus attempt to bridge the gap between religious beliefs and scientific understanding of mental health and examine how these might coexist as multifaceted mental health literacies in a population, and how these different literacies might be deployed. Twenty participants were interviewed for the present study. The interviewees were split into three separate profiles, caregivers of people with a mental illness (n = 8, mean age: 50), community members (n = 5, mean age: 40), and users with a diagnosis of mental illness (n = 7, mean age: 42.). In this paper, we will explore the variety of beliefs and practices described by participants and argue that the issue may be better understood in terms of multiple mental health literacies which people deploy in different circumstances. Even those skeptical of traditional and spiritual approaches are knowledgeable about them, and the traditional practices themselves often involve detailed regimes of activities aimed at effecting an improvement in the person's mood or condition. Therefore, we argue that it is appropriate to consider mental health literacy not as a unitary phenomenon but instead as a mosaic of different literacies which may be deployed in different settings and which may operate in synergy to enable treatment but also facilitate a sense of meaning and purpose.
| Mental Health Literacy in South Asian Countries | | |
Raghu Raghavan, Brian Brown, Nadia Svirydzenka, Asha Banu
Department of Mental Health, Mary Seacole Research Centre (Mental Health, Culture and Diversity), Leicester, England, UK
E-mail: [email protected]
Abstract
This first paper sets the scene by characterizing the notion of mental health literacy (MHL) and the problems facing mental health services in low- and middle-income countries (LMICs). MHL is defined as the ability by an individual to recognize specific disorders or different types of psychological distress but is equally relevant to communities. It is learning about not only the knowledge about risk factors and causes of various psychiatric disorders but also self-help, knowledge of professional services, and how to seek help and remain well. LMICs face specific challenges such as financial challenges, poverty, and inadequate services. Due to the prevailing consequences of mental ill-health on both the individual and community development, mental health problems have been stated to be one of the main causes of overall disease burden worldwide. This is particularly a concern among LMICs where limited resources are directed toward mental health. The WHO estimates that 76%–85% of people in developing countries do not receive any treatment for severe mental health problems, compared to 35%–50% of people in developed countries. Developing MHL of people from all sections of the society and communities in LMIC is paramount in improving mental health and understanding of mental illness. This paper explores MHL focusing on LMICs with special reference to South Asian countries (India, Pakistan, Bangladesh, and Sri Lanka). In order to improve populations' mental health, it is crucial to improve the people's understanding of mental illnesses ensuring that all sections of the society and communities in LMIC are involved if MHL is to improve. This paper will also address key issues related to components along with key factors associated with MHL in LMICs.
| Establishment of Outpatient Opioid-Assisted Treatment Clinics in Punjab: Training, Current Scenario, and Challenges Ahead | | |
P D Garg, Amarbirpal Singh, Manmeet Kaur
E-mail: [email protected]
Abstract
The use of opioids in the state of Punjab has acquired epidemic proportions and presents as a major public health concern. The appropriate management of such huge population of opioid-dependent patients requires adequate availability of treatment services in the state. Substitution therapies are most common among the suggested strategies to tackle the problem of opioid dependence in Punjab. The 29 opioid substitution therapy centers in the state of Punjab are functional through the support of the National AIDS Control Organization and Punjab State AIDS Control Society and give harm reduction services only for injecting drug users for HIV prevention. Despite these, the prevalence of unsafe injecting remains high and there was an urgent need in the state to expand the implementation of evidence-based drug treatment interventions and make full use of all therapeutic options for managing drug dependence and reducing harms from injecting. Hence, the Punjab Government and antidrug Special Task Force launched a pilot project to start outpatient opioid-assisted treatment (OOAT) centers located within/linked to public health settings for injecting and noninjecting opioid-dependent persons in the state which required adequately trained human resources. Five-day OOAT training was given to health-care workers of the whole state by the Department of Psychiatry, GMC, Amritsar. Under a pilot project, first OOAT centers were opened in Amritsar, Tarn Taran, and Moga in October 2017 by the Health Department. Currently, there are 202 OOAT clinics in the state to provide outpatient department-based treatment services for opioid-dependent patients. This symposium aims to discuss the experience and impact of training of health-care workers, clinical setup of OOAT clinics, current scenario, and challenges that lie ahead.
| Legal Aspects of Suicidality in India: Journey over the Last Three Decades! | | |
Vijender Singh, Devendra Singh Basera, Roshan Sutar, C Naveen Kumar
E-mail: [email protected]
Abstract
Construct of Suicidality – The legal understanding of the nature of suicide dates back to the times of St. Augustine (AD 354-430) for considering suicide as a sin or crime. Whereas, the religious school of thought still entertains the duality of nature of suicide such that the samadhi, a process of salvation, is not termed as suicide while suicide by other means is still given a negative connotation as “sin” that could halt the achievement of salvation (moksha). Journey of transition of the legal status of a suicide attempt – Till the last decade, in India, an attempt of suicide was punishable under Section 309 of IPC. Preceding the judgments of Hon'ble High Courts of Delhi and Bombay and in Supreme Court subsequently, recently, suicide attempt was “decriminalized” by the Mental Healthcare Act (MHA) 2017 under its section 115. However, the debate about its decriminalization is still going on. MHA 2017: Bane or boon for suicidality: MHA 2017 is going to be helpful for patients with suicidality, mental health professionals assessing them, and judicial bodies aligning with the public health-care delivery systems. Since the state must provide the proper care to the victim of suicide attempts, this has to be carefully weighed against the economic, political, administrative, medical, and legal resources of the country. Implication of MHA 2017 on current Legal Practice in India – Section 124 of MHA 2017 states that the person may be exempted from “punishment” and “not prosecution.” So here, a possibility will remain that the police can remand a person who attempted suicide and produce before a magistrate. Abetment of suicide is again a grey area with lots of practical difficulties being faced by psychiatrists.
| Uplifting Mental Health of Elderly Population: Through Intergenerational Solidarity | | |
Sandhya Gupta, Ramandeep Kaur, Veena Sharma, Prerna, Belsy Xavier, Jeayareka
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: During the pandemic, the announcement of lockdown and instructions for the prevention of infection transmission, particularly the older persons, were totally restricted to stay in house only. Even after the lockdown when unlocking was done, older persons were still housebound as they were most vulnerable. Intergenerational solidarity (IGS) refers to the degree of cohesion between different generations and cohesion results in the potential development of all ages. Objectives of the project are as follows: (1) To explore if IGS works effectively for maintaining the well-being of older persons (relationship of multigenerational society); (2) To explore the effectiveness of IGS on the mental health of older persons: Current scenario in India; (3) To explore for the use of improving the mental health of elderly through community Participation; (4) To explore the impact of COVID-19 pandemic on IGS; and (5) To explore the scope of practice for nurses in using IGS in improving the mental health of the elderly during pandemics. Methodology: A qualitative investigation was done into the impact of IGS during the pandemic lockdown period. The project is based on the participatory observation method. All the observations are done by family members and communicated with health professionals as there was no other option to collect data but to rely on WhatsApp video calls. The initiating IGS training was done by virtual platform with selected seven families having four generations living together. Findings: (1) Understanding IGS (relationship of elderly with younger generations) (multigenerational society): An intergenerational theory focuses on key concepts related to IGS: Intergenerational conflicts, multigenerational, intergenerational equity, intergenerational trauma, intergenerational relationships, and intergenerational responsibility. Nurses can assist people related to IGS and their solutions. (2) Emerging importance of mental health with IGS: Current scenario in India: In the Indian culture, three generations usually stay together in India. Since the family plays a key role in the care of the elderly, the extent of family support and quality of relationships are key determinants of the quality of life of the elderly. The relationships among family members can be in both directions, as older people provide significant support, and later in their life course with increasing age, they are more likely to become recipients of care. (3) Measures for improving IGS to improve the mental health of the elderly through community participation: Grandparents can be more actively involved in school. Going on vacation together, an outing or picnic, or having an adventure together can also contribute to improved communication. Economic empowerment of elderly by various means is needed. Celebration of grandparent day at school and community level also brings generation together at one platform. Involving mass media and social media to propagate the message of IGS can also contribute significantly to influencing the attitude of the young generation toward the care of the elderly. (4) Effect of COVID-19 pandemic on IGS with respect to psychological distress in the older person: Older adults are increasingly likely to live alone and have fewer opportunities for social interaction, recreational, religious, and utilitarian activities due to mobility difficulties and lockdown. During pandemics, the consequences of social isolation and emotional loneliness in older adults increase their vulnerability to mental distress. There are higher chances of worsening of preexisting medical and psychiatric illness due to difficulty in ensuring routine health care due to restrictions. The common mental illnesses in older adults are depression, delirium, and dementia. Worsening of these symptoms can add to the risk of infection to COVID-19 and its complications. (5) Role of nurse in improving the mental health of elderly through IGS during a pandemic: Various roles can be played by nurses in different settings in improving IGS. (a) Direct care provider: Counseling families in hospitals and communities about the issues related to mental health and promotion of IGS. Early identification of the families who are facing intergenerational issues and making referrals if required. (b) Educator and researcher: Nurses raise this awareness and conduct programs in schools, communities, and other public forums and do promotion of IGS. (c) Administrator in the health sector: For the promotion of IGS in the organizations toward the elderly, mobilization of policy to propagate the message by various means. Conclusion: Nurses can play an important role to bring about attitudinal changes in public for issues related to IGS conduct research to develop models of care based on IGS. There are myriad examples of younger people supporting older adults during their isolation and keeping them socially connected. There is a serious impact of the lockdown period, particularly on those with dementia/delirium due to their poor comprehension and managing guidelines for prevention. At the family and community level, intergenerational ties can be valuable for everyone for improving the well-being of one and all. All generations get benefitted and create a harmonious environment for growth and development. Despite apparent issues of the COVID-19 pandemic on older adults, there are some encouraging signs of IGS during this pandemic as for long weeks all families stayed together at home.
| Use of Technology in Attention Deficit Hyperactivity Disorder: Impact on Social Functioning | | |
Bikram Dutta, Siddhesh Shere, Soumyshree, Shivanand Kattimani
Base Hospital, New Delhi, India
E-mail: [email protected]
Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with significant economic and societal cost. Pharmacological and behavioral therapies have limited impact. Existing cognitive training programs have shown limited efficacy. Certain domains of ADHD can be improved through nonpharmacological interventions based on technology. Objectives: There is still debate on whether use of technology has led increase in the prevalence of ADHD or technology can mitigate dysfunction seen in ADHD. There are technical innovations from assessing ADHD symptom severity to those help in self-management. Delivery of digital treatment interventions may increase access to treatment, reduce cost of care, and increase compliance by making the treatment enjoyable and comfortable for use in an at-home setting. Students with ADHD frequently struggle with organization and time management. Methods: Technology-based tools are promising in promoting attention. They are classified as study skill apps, academic/learning apps, and organization apps. Older children required technologies more focused on self-management. Results: Whether findings extrapolate to real-word scenario is doubtful, its impact on ADHD symptoms but also on the functional impairments (e.g., academic, social) in daily lives. Conclusion: Many experts suggest that interventions aiming to facilitate self-management of ADHD should cover the following domains: positive rewarding feedback, downloadable gaming resources, personalizable and adaptable components, psychoeducation, integration of self-management strategies, goal setting, and context. Parents and health professionals endorse the importance of technology, however, need for monitoring and being practical tailoring to specific complex needs are still the shortfalls.
| Challenges Faced in Recovery from Substance Use Disorder: Role of Nurse | | |
Renju Sussan Baby, Sushil Kumar Maheshwari, Surbala Devi, Laxmi Kumari, K Thasleem Sabith
All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
E-mail: [email protected]
Abstract
Background: The paradigm shift in treatment of substance use disorders (SUDs) from acute care model to recovery-based model mandates the adequate training of nurses in the effective management of detoxification, handling lapses/relapses, identifying and managing physical and psychiatric comorbidities, and also preparing family to face the challenges in the process of recovery. Methodology: An experiential model is adopted in this project for evaluating the scope of practice and participation of sixty nurses in recovery-based model for relapse prevention inclusive of family intervention in a selected treatment facility. After a brief training for nurses, the data were collected by observation and narratives taken from SUD patients and their families and nurses did self-reporting. Objectives of the project in recovery management are as follows: (1) to find out understanding of nurses about the concepts, process, and principles of recovery-based model of treatment of SUD; (2) to explore if nurses could identify and manage uncomplicated and complicated withdrawals effectively; (3) to explore the extent of participation of nurses in developing individualized lapse/relapse management action plan; (4) to identify the level of skill development of nurses in detecting and managing physical and psychiatric comorbidities; and (5) To explore scope of nursing practice by empowering family to support the individual in his/her journey to recovery. The findings are as follows: (1) Recovery management model versus acute care model from SUD: process and principles: Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. An acute care model, often only those people with the most severe symptoms receive treatment. Recovery management model of care effects on long-term recovery maintenance could be easily used by nurses with a brief training. (2) Nursing care challenges during detoxification: Early recognition and treatment of withdrawal symptoms is critical for positive patient outcomes. Nurses should identify and handle withdrawal symptoms of patients with SUD and can contribute to accurately identify patients at high risk for complicated withdrawals. Skills of nurses in promptly meeting needs during the withdrawal phase of treatment were very effective and useful. (3) Nurses' role in developing individualized lapse management/relapse prevention action plan: Lapse is a single slip after a period of abstinence and the person gets back on the recovery path by early intervention. A relapse prevention involved planning for facilitating development of individualized relapse prevention action plan, such as what specific steps the person can take to stay safe if lapsed or relapsed. (4) Nursing care challenges in handling SUD with physical and psychiatric comorbidities: People who struggle with co-occurring disorders often find themselves between a rock and a hard place when seeking treatment for substance addiction, and if they do not stop using substances, their addiction will continue to worsen the symptoms of their mental health issues. It is imperative that individuals with comorbidity received addiction treatment and simultaneously for mental health issues. (5) Nurses working effectively with families for recovery from SUD: Family involvement and support allows recovering SUD patients to focus on their goals and start working toward realistic solutions to attain long-term recovery. Nurses empowered family to support the patients as well as own emotions and retaining in long-term recovery management program that encouraged them to adopt healthy lifestyle. Conclusion: Nurses had moderate understanding of recovery management model and relapse prevention in the treatment of SUD. This model enables the nurses to plan individualized recovery-based action plan involving family members. Effective management of lapses/relapses and handling occurring disorders are the major milestones in the path of recovery which is managed effectively by nurses. Nurse-led recovery management can be initiated in all facilities after giving relevant training.
| Nonsuicidal Self-Injury, Suicidal Behavior, and Suicide Prevention: Indian Perspective | | |
Hemendra Singh, Manaswi Gautam, Anita Gautam, C Swati
Department of Psychiatry, MS Ramaiah Medical College, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Dr. Anita Gautam will be talking about hidden epidemiology of suicide in India. More than one lakh persons (133,623) in the country lost their lives by committing suicide during the year 2015. Hence, there is need for developing a cost-effective module which can address individual-specific psychological stressors which are prevailing in Indian context. These psychological aspects can be delivered by a nonspecialist trained person. Dr. Hemendra Singh will discuss about the clinical correlates of suicide attempt in psychiatric patients. It throws light on association of nonsuicidal self-injury and suicidal behavior among psychiatric patients and need for developing a brief suicide prevention module. Dr. Manaswi Gautam discusses various strategies for suicide prevention. As history of suicide attempt is a risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide and also to rehabilitate them psychosocially. Dr. Swati C would be discussing her experience of delivering brief intervention module for suicide prevention.
| When Crises Combine: Global Perspectives on Homelessness during a Pandemic | | |
Raman Marwaha1,2, Consuelo Cagande3, David Beckmann4, Vidhu Kumar5
1Residency Program Training Director, Case Western Reserve University, 2Metro Health Medical Center, Cleveland, Ohio, US, 3Division Chief, Community Care and Wellness Program, Children's Hospital of Philadelphia, USA, 4Department of Psychiatry, Massachusetts General Hospital, Boston MA 19104 USA, 5Department of Psychiatry. Govt. Medical College Trivandrum, India
E-mail: [email protected]
Abstract
Homelessness is a social determinant of health which puts people who are experiencing them at risk during the COVID-19 pandemic. During this symposium, our panelists will discuss global perspectives on homelessness during a pandemic.
Topics and Speakers:
Dr. Cagande will discuss that the relationship between severe mental illness (SMI) and homelessness is a global issue. Although relationship and causality are not clear, there is evidence of association between homelessness and SMI. Furthermore, there is a paucity of available data from major cities. The last time a global survey was attempted by the United Nations was in 2005 and it estimated 100 million people were homeless worldwide.
Dr. Beckmann will discuss, in the United States, social services that prevent most unaccompanied minors from experiencing homelessness, but these safety nets disappear as soon as youth turn 18. They also do not prevent entire families from becoming homeless. Challenges of treating trauma (including caregiver rejection), substance use, and other issues in this demographic, in general and during the pandemic, will be discussed.
Dr. Kumar will discuss India's population experiencing homelessness which is 0.15% (1.77 million). There are significant barriers to implementing community strategies of social distancing and hygiene in homeless people during the pandemic. Steps to circumvent these barriers will be discussed. Homeless who are mentally ill and problems specific to them will be discussed. The efforts by the governments and civil society in India will be highlighted.
Dr. Marwaha will discuss how we can improve mental health treatments of people who are experiencing homelessness, how public health measures and policies can help, and how advocacy is important. To help with shortage in mental health workers, opportunities such as teleconsults and education of primary care providers will be discussed.
| Cultural and Ethical Perspectives on Internalized Transphobia | | |
Juan Maass, Josefina Cáceres Cortes, Fernando Lolas
Psychiatric Institute Dr. José Horwitz Barak, Santiago, Chile
E-mail: [email protected]
Abstract
Introduction: Prejudice toward transgender individuals can result in negative experiences with cumulative and long-lasting effects on mental health. One expression is internalized transphobia, a kind of proximal stressor according to the Minority Stress Model proposed by Ilan Meyer. Objective: To develop a cultural and ethical perspective on internalized transphobia with possible application in different settings. Background: Studies on the mental health of transgender individuals are scarce in Chile. A survey conducted in 2017 evinced a high prevalence of suicide attempts (56%), 48% of which were between the ages of 11 and 15 years. Another study reported suicide attempts of 27% between the ages of 16 and 18 years. In Latin America, studies reported have employed unspecific instruments in ambulatory settings. The lack of evaluations designed in the context of minority stress studies makes it necessary to device instruments appropriate for the assessment of internalized transphobia that is culturally relevant. Culture and Transphobia: On the basis of a clinical case, in which a differential diagnosis between personality disorder and chronic stress reaction is advanced, the need for specific evaluation procedures is emphasized. Considerations are put forward regarding the cultural determinants of diagnostic categories and terminology which in general depathologize transgressions to binary classifications of sexuality and remind experts and laypeople that anatomy is not personal destiny. Conclusions and Recommendations: From a practical standpoint, although gender incongruence (and its multiple designations in professional terminology) does not always demand medical interventions, it does demand support and compassionate understanding, guided by sound empirical evidence. Since health-care systems do not seem to be fully prepared to diagnose and provide guidance, the task ahead is a comprehensive approach including cultural and ethical elements. The “moral distress” that sometimes is equated to anxiety and despair needs to be acknowledged and considered in the context of the “moral determinants” of health and well-being, preceding, and modulating traditional socioeconomic determinants. Practitioners in the field of mental health need to be trained in appropriate “translational practices,” in which both scientific and ethical concepts are specified and contextualized in order to develop adequate guidelines for diagnosis and support of transgender individuals experiencing internalized transphobia.
| Teaching Psychiatry Nursing in Pandemic: Simulation-based Education | | |
Sandhya Gupta, Srinivasan Muthuvenkatachalam, Sushil K Maheshwari, Laxmi Kumari, Monica Sabharwal
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: Face-to-face teaching and learning were converted to virtual remote learning and clinical experiences suspended to protect the students from the infection in pandemic. The sudden announcement of lockdown and thereafter the restrictions imposed due to in pandemic made imperative to search for alternatives for completing learning requirements of students in nursing colleges. Methodology: Simulation-based education (SME) is the main method of teaching, which is utilized by all the health professions educational institutions as there was no other option to continue training students of nursing colleges. Kirkpatrick's evaluation model was used for assessment of training outcomes. The objectives of initiating SBE in training of psychiatric nursing are as follows: (1) to develop a model for training of psychiatry nursing in pandemic; (2) to determine role of faculty in maintaining psychological safety in simulation-based training; (3) to use of boot camp approach for teaching therapeutic communication by SME; (4) to use protocols for assessment of psychiatric nursing skills using SBE; and (5) To empower students to return to clinical work post unlocking in pandemic. The findings are as follows: (1) averting future injustice in training: Coping with uncertainty: in Pandemic: Specific response to pandemic has been shaped by contextual factors, especially the level of information technology infrastructure development and access to such technology negatively affected the training during the lockdown. If adequate measures are put in place by preplanned mitigation strategies, future crises like pandemic will have less impact on nursing education. (2) Psychological safety in simulation-based training: Role of faculty: Despite efforts to prepare a psychologically safe environment, simulation participants are occasionally psychologically distressed. There is need to develop guidelines for simulation educators about participant psychological risks and need for having a plan for identification of psychological distress so that simulation educators may assist them for psychological safety. (3) Teaching therapeutic communication by SBE: A boot camp approach: SBE has a long history in teaching in nursing colleges. The classic studies involved simulated environments in teaching basic nursing procedures, yet, relatively speaking, the limited amount of research into this topic indicates that SBE is either underused, or underresearched. A review of 458 articles on simulation in health care found that 95% used simulation in teaching technical procedures but were extremely limited use in teaching therapeutic communication to nursing students. Boot camp approach provides peer support in learning. (4) Protocols for assessment of psychiatric nursing skills: Effective learning outcomes are reported in a developing standardized roleplay as in Kirkpatrick's evaluation model. This model adds to the efficiency of learning the principles of clinical training of nursing students, so that they could demonstrate higher quality of evaluation of clinical skills. (5) Empowering students to return to clinicals through simulation training: holding bull by the horn: Most of the nursing students experienced an initial lack of confidence, post-COVID pandemic unlocking with 36% requiring 1–3 months or longer for their confidence to return. Prolonged lack of confidence was associated with longer time-out of training and educational activities. Conclusion: There is an urgent need for developing hybrid training models for teaching psychiatric nursing in view of COVID-19 pandemic in the year 2020 till now. The students must be assessed for the underconfidence due to sudden cessation of to return to clinical work to prevent poor learning outcomes. The regulatory bodies need to develop policy for limiting overuse of virtual method and prevent noncompletion of various requirements by nursing students due to restrictions imposed in pandemic.
| Tobacco Harm Reduction – Global Recent Updates | | |
Gayatri Bhatia, Prabhu Dayal, Ankita Chattopadhyay
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: Although smoking cessation is currently the only guaranteed way to reduce the harm caused by tobacco smoking, another reasonable approach may be to try and reduce the harm from continued tobacco use among smokers unable or unwilling to quit. Possible approaches to reduce the exposure to toxins from smoking include reducing the amount of tobacco used, and using less toxic products. Commonly used harm reduction approaches for tobacco are potential reduced exposure tobacco products, electronic nicotine delivery systems, and smokeless tobacco alternatives like Swedish snus. Objectives: This symposium aims to discuss theoretical background and evidence base for different tobacco harm reduction products along with their public health and policy aspects. The current global scenario of availability and acceptability of harm reduction measures along with recent advances will also be discussed.
| Religion in the Current Sociopolitical Context – A Perspective from Different Religions and Social Psychiatry | | |
Narpinder Malhi, Driss Moussaoui, Shridhar Sharma, Mark Famador, Varghese Punnoose
Christianacare
E-mail: [email protected]
Abstract
Objectives: Religion is the source of values such as compassion and social justice that are essential to the harmonious coexistence of diverse groups in any given society. Simultaneously, few individuals or groups can interpret it to rationalize intolerance and injustice toward others, which is the root of conflict and suffering. The problem becomes predominant when religious extremist views and a phobia of other religions cause a divide in society and pose a threat to well-being of others. In this presentation, we aim to discuss the impact of politicization of religion in global perspective and mental health. Methods: The presenters will discuss the following topics: (1) major current political events centered on different religions in various parts of the world, (2) impact on mental health with recent rise of religion-based hate crimes, and (3) discuss role of social psychiatrists in providing care and advocacy for those affected. Results: As per FBI hate crime statistics report 2019, incidents related to religion increased 7% from 2018 in the United States. The largest rise was in anti-Semitic followed by anti-Muslim and anti-Sikh (which increased by 145%). Studies have reflected a positive association with psychological distress, depression, fear and anxiety, anger, posttraumatic stress disorder, and difficulties in individuation-separation in child survivors of hate crimes. Conclusions: In the current sociopolitical environment, social psychiatrists can play a significant role in addressing the mental health needs of these patients by establishing collaboration with religious communities to reduce mental health sufferings and improve adaptive skills. In addition to practicing cultural and narrative humility, practitioners can integrate trauma-informed approach to provide care to these patients to enhance recovery from intergenerational trauma.
| Risk Factors Associated with Initiation and Development of Substance Use: Identification and Management | | |
Gauri Shanker Kaloiya, Prabhu Dayal, Prashant Mishra, Jay Singh Yadav, Sufia Ahmed
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Substance use is highly prevalent across the culture and country. Several factors are found to be responsible for initiating and maintaining the substance use behaviors. There are many such factors which make the problem worse. Many of these factors can be avoided, but some of them are inevitable. Persons with substance use disorder have to learn to manage such factors with appropriate medicines, coping, and problem-solving skills. Factors responsible for initiation and maintaining the substance use may be related to the individual/peer, family, community, profession, and stages of development such as adolescence, youth, and old age and to some extent laws of the country. The factors related to the person are mainly associated with temperament, personality, trauma, and abuse. Family factors such as poor parenting, expressed emotions, and social factors such as peer pressure and working culture play important role in development of substance use. Loneliness, neglect, abuse, insomnia, etc., at old age may be associated with substance use in older adults. The use of illegal/illicit substances causes confrontation with existing laws of the country and sometimes affects the process of identification and proper treatment of such users.
| Psychiatric Morbidity and Substance Use in Migrant Population: Magnitude, Assessment, and Treatment Model during COVID-19 Pandemic | | |
Gurvinder Pal Singh, Ajeet Sidana, Subhash Das
Government Medical College and Hospital, Chandigarh, India
E-mail: [email protected]
Abstract
There are around 30 million migrant workers in India which is equivalent to 28.3% of the workforce in India. Migrant workers belong to the marginalized and underprivileged section of the society and therefore more prone to social, psychological, economical, and medical diversity. Migrants are more susceptible to mental health problems such as depression, anxiety, and substance abuse. There are various stressors encountered by the migrants in the form of language and geographical barriers, unpredictable work environment, job insecurity, living away from family and friends, lack of support at the workplace, etc., which further increases the probability of mental health problems in this vulnerable section of the society. The impact of the COVID-19 pandemic and lockdowns further leads to unemployment and misery. Prevalence of mental health and substance use disorders in the migrant population in India has shown higher rates in comparison to the general population. A study from Karnataka had reported the prevalence of mental health problems and alcohol and tobacco abuse (smokeless and smoking tobacco) to be 19%, 21%, and 23.5%, respectively. Another multicentric study from India reported that the prevalence of ever use for all the substances was 45.3% and at least one psychiatric diagnosis was 13.45%. The prevalence of alcohol, tobacco, and cannabis was higher than the general population. Since these migrant laborers keep on moving from one place to another place and do not perceive or have time to visit hospitals for mental health and substance use problems, there is a need to develop treatment strategies/model(s) to reach this unreached, underprivileged section of the society. The symposium will have the following subthemes;
| No More in Silo? Health-Care Institutions and Psychiatry in Pandemic Era | | |
Swapnajeet Sahoo, Shree Mishra, Susanta Kumar Padhy
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
COVID-19 pandemic has been mainly shouldered by the health-care institutes relentlessly for the last 2 years. It took a toll on the mental health of every cadre of the workforce engaged in patient care. Apart from the psychological distress, it unearthed the multiple challenges in health-care organizations, especially related to human resource. On the one hand, positive attributes such as positive coping, problem-solving, leadership, and positive risk taking and safeguarding the health-care workers built endurance, and on the other hand, the existing conflicts, poor group motivation, organizational grievances, and public attitude toward carers were issues that surfaced during this protracted global pandemic. Low- and middle-income countries where health-care services are not homogenous and the systemic failures being often attributed to doctors might lead to poor execution of pandemic-related services.
In such a situation, the psychiatrists' skill set, which is often underexploited and role beyond treating psychiatric disorders, becomes pivotal in addressing such complex human dynamics in large organizations. Health-care institutes would benefit in including psychiatrists in areas addressing human resources for timely addressal of such issues.
This symposium will cover the various skills, roles, and challenges of a psychiatrist in health-care organizations. It will also discuss the understanding regarding human resource dynamics in an unprecedented and uncertain challenge of the current pandemic. It will explore the way forward specifically the lessons learned by psychiatrists during this humanitarian crisis and whether it can be extrapolated toward proactive integration of psychiatry into workforce welfare in health-care organizations.
| Biopsychosocial Model of Farmers' Suicide in Indian Context: How True? What to Do? | | |
Kshirod Mishra, Sally John, Manik Bhise
Department of Psychiatry, MGIMS, Sevagram, Wardha, Maharashtra, India
E-mail: [email protected]
Abstract
Farming as an occupation is associated with several stressors from physical to biological and psychosocial. Farmers are vulnerable to occupational hazards in the form of climatic changes, exposure to hazardous chemicals such as pesticides and herbicides, changing market trends, poor government policies and planning, geopolitical situations, and lack of aptitude among the younger generation in farming as a lucrative or an alternative option in the recent past. Farmers from northern states are agitating for several months due to a change in government policies regarding the selling of goods. Those protesting farmers are exposed to adverse climatic conditions such as extreme heat to cold with minimal protection, poor habitability condition, special situations such as the ongoing COVID-19 pandemic with the risk of infection due to overcrowding, and other associated mental and physical stresses. On this background, we intend to discuss the biopsychosocial factors which are associated with farmers' suicide in different parts of Indian subcontinent.
| Medical Education in Psychiatry: Addressing the Challenges during COVID-19 Pandemic | | |
Joseph Varghese, A Nisha, Neetu Kurian, Sreeja Sreekumar, Sreeja Sahadevan
E-mail: [email protected]
Abstract
Psychiatry is probably the most interpersonally interactive medical specialty. The undergraduate and postgraduate trainees need to observe the clinical interaction between faculty and patients, during their training in psychiatry. After relentless brainwork, India had just implemented the competency-based medical education curriculum in 2019, when COVID-19, one of the worst pandemics of the century, struck our country. The whole process of skill-based learning has been disrupted or limited, as a consequence, and it is currently unclear whether virtual means of observation are as effective as the original. Our proposed symposium titled “Medical education in Psychiatry: Addressing the challenges during COVID-19 pandemic,” in a nutshell, highlights the changes which took place in psychiatry training during COVID-19, barriers encountered in adapting to the new system, and methods chosen to keep the ball rolling. Prof. Joseph Varghese P will be chairing the symposium. Dr. Nisha A will speak on “Medical Education in India during COVID-19 pandemic,” giving an overview of the impact of COVID-19 in the medical education field of India. Dr. Neetu Kurian will speak on the topic, “Undergraduate training in Psychiatry during COVID-19.” She will bring out the modifications adopted so far, in undergraduate psychiatry training in medical colleges of India. Dr. Sreeja Sreekumar will talk on “Postgraduate training in Psychiatry during COVID-19,” spotlighting the changes which happened in clinical training, didactic sessions, research, and conduct of university examinations as part of postgraduate psychiatry training during the pandemic. The concluding topic, “Innovations to overcome the challenges in Psychiatry training during COVID-19,” will be presented by Dr. Sreeja Sahadevan. She will speak on time-tested and novel ways and platforms of virtual training in psychiatry, which may be attempted to bridge the existing gap in medical education created by COVID-19, in a developing country like India.
| Pandemic and the Persons with Developmental Disabilities | | |
Priti Arun, Shivangi Mehta, Reena Jain, Wasim Ahmad
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
E-mail: [email protected]
Abstract
The emergence of COVID-19 pandemic was a conundrum which has affected the lives of the persons with developmental disabilities in more ways than one. As it was an unforeseen event with no appropriate knowledge of means to continue minimalistic life, the resulting dearth of resources due to lockdown posed a challenge in itself. The pandemic did leave many scarred with losses – financial, social, and emotional, but it also integrated the families, strengthening the emotional bonds, and brought out many positive changes in lives of persons with developmental disabilities. However, the Government Rehabilitation Institute for Intellectual Disabilities (GRIID), Chandigarh, decided to help and continue the academics needs of children with ID&D through online platforms. Follow-ups were made by visiting one to one along with available digital platforms, including Google Meet, Zoom, and WhatsApp. The teachers' trainees prepared under college have been a great help in ensuring continuity of education and other academic needs of children with ID&D at doorsteps. For continuation of clinical care, online audio and video consultations and therapies, online counseling for parents, and providing home plans to parents for therapies of children at home were done. Community-based identification of people with disability and rehabilitation and counseling were continued, as were the UDID certification. Even the medicine distribution at doorstep was provided along with COVID awareness and vaccination for patients. Getting lives of persons with developmental disabilities back on track amid the pandemic is a daunting task. The GRIID has restarted many services (clinical services, therapies as well as rehabilitative) both online and offline. Besides arranging camps for vaccination of persons with DDs, the shelter workshops will be boon to help in engaging them to learn new tasks as well as provide respite to family members to avoid burnout.
| Innovations for Mental Health Care of the Elderly | | |
Om Prakash, Shrikant Srivastava, Bhaskar Mukherjee, Jayashree Dasgupta, Vijay Kumar
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India
E-mail: [email protected]
Abstract
Mental health care in the elderly has undergone a dramatic change in the last two decades. The mental health care itself has moved from traditional methods of treatment to newer innovative methods that are beginning to understand and embrace the intricacies of mental health. The symposium addresses innovations in treatments and techniques which have drastically changed the mental health-care field for the elderly. Advancements in psychopharmacology relevant to geriatric psychiatry have focused on Alzheimer's disease, depression, and end-of-life care. Pathology-to-drug discovery approach is applied for designing and developing new medications with novel mechanisms of action (like D3R antagonists, vortioxetine, and esketamine). Secondary prevention strategies with glutamatergic agents (mGluR2/3 agonists) or negative allosteric modulators of CB1 (cannabidiol) are under study. Amyloid and tau PET radiotracers are available to aid the diagnosis of Alzheimer's disease. Recent evidence finds the benefit of psychedelic-assisted psychotherapy in end-of-life and cancer-related depression/anxiety. Advancements in technology and its applications have made a significant impact in mental health care of the elderly. Telepsychiatry for this group has great potential to increase access to physician, reduce travel times for patients and carers, and reduce health-care costs. Artificial intelligence has emerged as important innovation in the mental health fields, having potential in geriatric psychiatry. The use of smartphones and remote technology devices in mental health care of the elderly has started. Psychotherapy research has also moved from individual patient care to cost-effective public health strategies and treatments. Internet-based treatments and e-mental health tools are going to play an important role in mental health care.
| Educational Environments and Youth Mental Health | | |
Olga Pazyna, Natalia Treushnikova, Alla Kholmogorova, Vladimir Borodin, Janna M Glozzman
Union for Mental Health of Russia, Russia
E-mail: [email protected]
Moderator: Natalia Treushnikova, President of the Union for Mental Health of Russia, Chair of the Russian Organizing Committee of the Congress on Mental Health: Meeting the Needs of the XXI Century
Abstract
According to the WHO data, 10%–20% of the world youth population suffer from mental disorders, half of which develop before the age of 14, and three quarters – before the age of 20 (Child and adolescent mental health/WHO//https://www.who. int/mental_health/maternal-child/child_adolescent/en/). These numbers indicate the crucial importance of preventive measures at the early stages of people's lives to preserve their mental health and develop their individual spiritual, physical, social, and economic capabilities, which, in turn, are of primary value for the well-being of any socioeconomic system in modern society. Educational environment, in this sense, has an important influence on every student's health through creating favorable conditions to reduce mental health risks.
The Symposium “Educational Environments and Youth Mental Health” aims to review the evidence and to discuss the contents of educational environments concerning youth mental health as well as methods that could be used to make educational efforts productive and attractive.
Presenters:
“Education and Mental Health: an Epidemic of Perfectionism and Depression Among Adolescents and Students:” Alla Kholmogorova, Professor of Psychology, Head of Faculty of Counseling and Clinical Psychology at the Moscow State University of Psychology and Education, Leading Researcher of Sklifosovsky Emergency Medicine Institute, Vice-President of Russian Association of Psychotherapy, Council Member of Russian Society of Psychiatrists, Founder Fellow of Academy of Cognitive Therapy, Chief Editor of the Journal of Counseling Psychology and Psychotherapy
“Education for Child and Adolescent Psychiatrists:” Vladimir Borodin, MD, Vice-president of the Union for Mental Health, Professor and member of the Council on Social Psychiatry of the Serbsky Federal Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Chair of the Scientific Committee of the Congress on Mental Health: Meeting the Needs of the XXI Century
“Pediatric Neuropsychology:” Janna M. Glozzman, President of International Society of Applied Neuropsychology (ISAN), Research Director of the Luria Research Center for Developmental Neuropsychology, Professor of the Psychology Department at the Lomonosov Moscow State University (Russia)
“Mental Health Education for Adolescents and Youth: Practical Approaches:” Olga Pazyna, PhD (Economics), Vice-President of the Union for Mental Health of Russia.
| Impact of Childhood Adversities during COVID Pandemic and Fostering Resilience | | |
Shivanand Kattimani, Siddeswara Bargur Linganna, Siddhesh Shere, C N Sowmyshree, Bikram Dutta
Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
E-mail: [email protected]
Abstract
COVID-19 pandemic has affected everyone. Children have been exposed to many adversities during the current medical pandemic. These adversities may likely impact their future. Effort should be targeted at identifying at risk population within the children who are at higher risk for having the impact of the adversities. Resilience is the process through which children can have favorable outcome despite faced with adverse experiences and situations. In the previous medical pandemics, children were the most affected group. Interventions in the form of psychological first aid using general public and use of various psychosocial interventions have been used. Apart from resilience-enhancing training, peer-led cognitive-behavioral therapy have been delivered in the group format, and through computer-based programs, helplines, mobile and hotlines in the previous pandemics. Many of these were found to be effective. Few more interventions are ongoing trial around the world. Resilience-enhancing interventions can mitigate the adverse impact of the situation. They can be at the primary, secondary, and tertiary levels. Low- and middle-income countries lack skill human resource, and coordination. Many interventions may require cultural adaptation. Practical ways of developing the content and difficulties in implementation and ways to mitigate the difficulties will be discussed. The use of artificial intelligence in developing models and modes of delivery will be explored.
| COVID-19 Pandemic and Mental Health of Children | | |
Nivedhitha Selvakumar, Rajesh Sagar, Bichitra Nanda Patra, Deeksha Kalra
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
The COVID-19 pandemic has left a lasting impact on the mental health of children of the current generation. It has been estimated that around 90% of the world's student population have been locked out of school. The mode of education has largely transformed to online platforms which unfortunately leaves children with limited resources at a disadvantage. The opening of schools also poses a major challenge to both the school authorities and student community. Some of the major concerns are that the children might be unable to follow the preventive guidelines effectively and can also act as asymptomatic carriers of the disease, thereby leading to a major disruption in their academic life. The home confinement of young children has been shown to impede social development and lead to an increase in anxiety, depression, and other mental health symptoms. The children with preexisting psychiatric disorders and developmental disabilities have emerged as a particularly vulnerable population. Their lives have been impacted by disruption to their medical care and closure of special schools which focused on the rehabilitative measures. Most online platforms are not compatible with assistive technology required for teaching these children. Another major psychosocial stressor encountered by children during the COVID-19 pandemic has been witnessing the death of one or both of their parents and relatives during the peak of COVID waves. They have also become the silent victims of unemployment, poverty, and migration. Hence, it is of utmost importance to focus on the mental health needs of children to allay the effects of this pandemic.
| Unfolding the “Resilience” in Disaster Psychiatry and Way Forward to Resilient India | | |
Roshan Sutar, Vijender Singh, Devendra Basera
AIIMS, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Understanding the concept of resilience: Contemporary understanding of resilience in disaster psychiatry is the ability of a system to respond positively in different phases of disaster. Although resilience is an individual trait, it can be seen at the level of communities and states. The confusion lies in understanding the different terminologies such as community resilience, disaster resilience, psychological resilience, disaster-resilient society, disaster risk reduction (DRR), disaster preparedness, and disaster mitigation. Resilience is the key to preparedness: The first major disaster which opened the eyes of mental health professionals in India was the Bhopal gas tragedy that made a clear understanding of short- and long-term consequences on mental health. The shift in the understanding of disaster psychiatry in recent decades from response to preparedness under the broad strategy of DRR, is gaining significant attention. What appears to be the most important but least prioritized under policy and act is preparedness in terms of mental health. The amalgamation of the concept of disaster preparedness and mental health could be an integral part of the resilience-building strategies of the country. Resilience and possible framework in the Indian context: Although considerable community resilience was observed during earlier disasters as well as during the COVID-19 pandemic, a more structured and systematically delivered training could greatly help for building innate resilience. Considering the reduced allocation of GDP to mental health in India, the concept of resilience is a serious challenge in the absence of a strong framework that could ease task sharing and capacity building. The researchers need to focus on developing strategies to utilize existing resources for building resilience. The symposium unfolds the “resilience” in disaster psychiatry and focuses on task sharing, capacity building, and digital training and proposes a community model to envisage disaster resilient India.
| Sociocultural Determinants of Treatment Seeking in Indian Setting | | |
Mukesh Swami, Naresh Nebhinani, Navratan Suthar
Department of Psychiatry, AIIMS, Jodhpur, Rajasthan, India
E-mail: [email protected]
Abstract
Objectives: To discuss various sociocultural factors related to treatment seeking in Indian setting with a specific focus on stigma and faith healing. Description: According to the National Mental Health Survey 2016, almost 10.6% population is suffering from mental health disorders. Despite this substantial load of psychiatric morbidities, the treatment gap is huge (more than 60%). Sociocultural factors are important determinants of treatment seeking in psychiatry such as education, employment, understanding and cultural meaning of psychological problems, stigma, and visiting and preferring to faith healing practices. Among these, stigma and faith-healing practices are important and dominating factors determining treatment seeking as well as adherence to the treatment. The stigma of mental illness not only prevents people from seeking help but also is an important factor for treatment dropout. Self-stigma can contribute by denial of illness that ultimately leads to delay treatment, adversely affecting the prognosis. Similarly, faith healing is an important determinant leading to delayed treatment and treatment dropout. In the Indian setting, various models have been adopted to accommodate deep-seated trust in faith healing among the community.
| Artificial Intelligence in Psychiatry | | |
Ashish Pakhre1, Vijender Singh1, Roshan Sutar1, Vikas Menon2
1All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, 2Department of Psychiatry, JIPMER, Puducherry, India
E-mail: [email protected]
Abstract
Conceptual understanding and basics of artificial intelligence (AI) in health care: It is crucial to understand the conceptual basis of AI technologies and how such technologies can pave way to improve efficiency, safety and access to health-care services, and digitalization of medical care. AI refers to computer systems that provide a specific domain of human intelligence, reasoning, and problem-solving. AI has a broad range of intelligent processes and behaviors created by computational models and algorithms. Machine learning is the most common approach in AI and refers to a system that teaches a predictive model by recognizing patterns of data from inputs and generates useful predictions. It is widely used in robotics and other AI technologies. AI in psychiatry overview: AI provides psychiatrists to redefine mental illnesses more objectively than currently done in classificatory system, recognize these disorders at an early stage when interventions may be given, and provide personalized treatments based on patient's specific characteristics. It is important to enhance the understanding of interactions of biological, psychological, and social domains. Pathophysiology of psychiatric disorders is often heterogeneous, and recognition of biomarkers will allow a proper objective and clear identification of mental illnesses. AI can generate better screening tools and prepare risk models to figure out predisposition of developing mental illnesses. Current status of research in artificial intelligence and psychiatry across the world: Models for predicting antidepressant response and digital intervention for anxiety and depression, tools to improve behavioral symptoms of autism, suicide prevention, dementia care, and identification of early stage of illnesses. Machine learning models have been studied in delivering psychological interventions domains. Ethical and technological challenges: Data availability, reproducibility, longitudinal data, heterogeneous and incomplete data, confounding problems, legal concerns, and data ethics issues need to be understood. It is also crucial to comprehend ethical and societal implications and concerns this technology can give rise.
| COVID-19 Pandemic and Children: Spotlight on the Mental Health Consequences, Evaluation, and Recommendation | | |
Jitender Aneja1, Naresh Nebhinani2, Suravi Patra3
1Department of Psychiatry, All India Institute of Medical Sciences, Bhatinda, Punjab, 2Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneshwar, Orissa, 3Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
E-mail: [email protected]
Abstract
Children of this century have borne the wrath of the yet untamed COVID-19 pandemic, a bit differently from the rest of population groups. Fortunately, the physical morbidity and mortality due to the COVID-19 virus has not been vile to children, but the psychosocial impact has been ominous. The restriction of children to their homes in view of closure of academic institutions and lockdowns, nonavailability of vaccine for the majority till present, infection and subsequent consequences for their parents, and changes in daily routines and lifestyle of children have taken a toll on their mental health. The social consequences such as school dropout, broken/disrupted families, being rendered orphan, and susceptibility to child abuse (such as domestic violence or trafficking, child labor, or sexual exploitation) are some of the challenges for not only the underdeveloped countries but equally so for the high-income countries. This symposium shall address the psychosocial impact of the COVID-19 pandemic on children in general as well as the special populations. The second part will take up the lacunae in the evaluation of mental health impact of the pandemic on the children followed by the discourse which will attend to the need of hour vis-a-vis long-term management of such consequences.
| Adoption and Mental Health: Challenges and Opportunity, a Social Psychiatry Perspective | | |
Snehil Gupta, Rajesh Sagar, Jyotsna Jain, Suravi Patra
All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Background: Adoption is the process through which a child who is orphaned, abandoned, or surrendered is legally provided with parents who are not the biological parents of the child. Both adoptees and prospective adoptive parents (PAPs) face several psychosocial challenges. COVID-19 pandemic has posed huge challenges in the whole process of adoption. The lack of skilled mental health professionals (MHPs) to address the unique needs of both parties is another area requiring attention. However, the title has been discussed in psychiatric literature. Objectives: To highlight the overview of the process of adoption, the mental health aspect involved with the adoption, the challenges and opportunities posed by the COVID-19 pandemic, and the need for specialized training in psychiatry on it. Methods: A literature review would be done on the topic, and relevant information shall be critically analyzed and presented in the form of the symposium. Results: Adoption is a less opted path given many social and systemic hurdles. Psychosocial factors (stigma, lack of social support, financial constraints, difficulty in performing parenting roles [for PAPs], and adverse past experiences, for example, neglect, abuse, and lack of early developmental nurturing [for adoptee]) play a crucial role in this process and thereof. COVID-19 has shown the inherent flaws with the existing adoption process; the unpreparedness of the system has left behind the adoptees and the PAPs in a state of dismay. Skilled MHPs and trainees to cater to the needs of the adoptee and PAPs are lacking. The country needs to design culture-specific interventions, including formal training for the MHPs and trainees in this subfield. Conclusion: The dynamics of adoption need to be delineated and addressed by skilled workforce, formal training in this subfield of social and behavioral science. The country needs to design intervention that is adaptive to the Indian context.
| Innovations in De-addiction Service Delivery during COVID-19 Pandemic | | |
Harbandna Sawhney, Mina Chandra, Shrishti
ABVIMS and Dr RML Hospital, New Delhi, India
E-mail: [email protected]
Abstract
COVID-19 pandemic posed new challenges for de-addiction service delivery. Our center, with a dedicated de-addiction setup had to quickly adapt to cater to the new demands. These challenges provided an opportunity to strengthen the existing services to keep up with the changing requirements.
1. Barriers and challenges for de-addiction service delivery in the context of COVID-19:
The service delivery at our de-addiction centers faced issues such as overcrowding, enhanced risk of COVID-19 exposure and shortage of staff, and increase in complicated withdrawal cases. The patients had difficulty in accessing the facilities due to closing of transport facilities, avoiding exposure to COVID-19 and financial losses. This led to drastic reduction in number of admissions at the de-addiction center.
2. Hybrid and holistic model of de-addiction service delivery:
COVID-19 provided opportunities for functioning de-addiction facilities to improve logistics; innovate by using teleconsultation services and virtual platforms; provide emergency suicide helplines and help create novel psychosocial support systems such as community and religious organizations, workplace colleagues, and nongovernmental organizations; and undertake virtual awareness drives, thereby breaking stigma and culture of silence usually accompanied by substance use in low- and middle-income country contexts. Our center also shifted to digital record keeping focusing on detailed evaluation where along with details of substance abuse, other aspects including cognitive, metabolic profile, pathways of care, prevalence of behavioral addiction like Internet addiction, stressful events, and factors affecting relapse of patients were assessed in detail using Mobile (Android) App.
3. Innovative nonpharmacological interventions:
Novel methods of nonpharmacological interventions were utilized. While patients continued visiting hospital for pharmacological treatment, teleconsultation services and visual platforms facilities were made accessible to clientele for therapy services including psychoeducation, motivation enhancement therapy, and relapse prevention therapy for patients and supportive psychotherapy for caregivers. In addition, audio clips with focus on psychoeducation regarding substance addiction were made available to patients. Telehealth Satisfaction Survey (Morgan et al.) was used in patients using online platforms to get objective feedback and understand how patients perceived digital consultation and interventions.
| Caring for the Carers: Psychosocial Impact of COVID-19 on Mental Health Professionals and Possible Interventions | | |
Vaibhav Patil, Gagan Hans, Rachna Bhargava, Anamika Sahu, Divyani Khurana
Department of Psychiatry, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
The spread of COVID-19 in the Indian subcontinent has increased the demands on the health-care sector. The constant rise in the rate of infection during the first and second waves has impacted the mental health of even the health-care providers. Over the last 1½ years, health-care providers have been affected due to an increase in infected cases, lack of any specific medicine or vaccine, lack of workforce, lack of infrastructure, lack of personal protective equipment, and feelings of inadequate support. Likewise, there has been an impact on the lives of mental health-care professionals. The increasing mental health issues during COVID-19 among the general population and health-care workers have impacted the mental health professionals to a great extent. Mental health professionals have been dealing with increased caseload and managing additional responsibilities such as COVID-19 training and duties. The transition of health-care services to the technological platform in terms of telepsychiatry and telepsychotherapy has led to blurring of duty timings with several phone calls and E-mails for digital consultation at any time, thus adding to the stress of mental health professionals. Therefore, developing an understating and integrating approach to prevent burnout and support the mental health-care professionals is the need for the hour and will be the focus of the presentation.
| Psychosocial Impact and Response of COVID-19 in a Resource-Poor State of Manipur | | |
R K Lenin Singh, Senjam Gojendra Singh, Athokpam Ranita
Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India
E-mail: [email protected]
Abstract
Introduction: Dr. R. K. Lenin Singh – Chairperson (Member of NAC of World Association of Social Psychiatry): The impact of COVID-19 is unprecedented in nature causing a significant threat to the psychosocial well-being of an individual. From March 2020 to June 2021, altogether 69,790 were infected, out of which 1150 have died. At the same time, mental health facilities are closed in Manipur, thereby causing enormous inconvenience to the general public. Stigma and discrimination also played major challenges in the containment of the pandemic. Different psychosocial measures were taken up by the private and public sectors. Response from Regional Institute of Medical Sciences (RIMS), Imphal: Dr. S. Gojendra Singh: Regional Institute of Medical Sciences (RIMS), Imphal, the only Central Government tertiary care hospital of the state, responded to the pandemic by forming a rapid response team. A team comprising mental health professionals, psychiatrists, and psychologists of the Department of Psychiatry and clinical psychologists formed “mental health teleconsultation service” and initiated counseling and treatment for various mental health problems related to COVID-19. State response: Dr. A. Ranita Devi: One state- and 16 district-level psychological support teams for all the districts and extended psychosocial support by engaging other stakeholders to reduce stress, anxiety, and mental health issues faced by the public. This presentation will review those initiatives by the state and district psychological support teams of Manipur under the state health department, including telecounseling, awareness camp, field visits, and IEC activities in media. Conclusion: Dr. R. K. Lenin Singh: In spite of all the measures taken up to contain the pandemic, the positive rate and mortality rate are increasing and highest in the country at this point of time. Hence, we have to enhance our response. In this regard, we will be requiring more workforce and resources.
| Tele-Psychosocial Rehabilitation: Blessing in Disguise | | |
Jyoti Mishra, Priti Arun, Shikha Tyagi
Government Medical College and Hospital (GMCH), Chandigarh, India
E-mail: [email protected]
Abstract
Mental health professionals across the world have been presented with the unique challenge of delivering mental health care during the COVID-19 pandemic. The pandemic has led to temporary closure of outpatient rehabilitation services at many places across the world and in India too. Telepsychiatry services did provide some respite to the agony of persons with mental illness and their family members. However, COVID-19 proved to be a nightmare for persons with severe mental illness (SMI) who had been attending rehabilitation services for many years. The Department of Psychiatry, Government Medical College and Hospital (GMCH), has been running rehabilitation services since 2013 and has been offering daycare services, vocational rehabilitation, social skills training, neurocognitive rehabilitation, and job placement services for persons with SMI; with around 60 patients attending these services on a daily basis. Disruption of these services proved to be taxing for the family members of patients, as the patients were entirely at home leading to increased IPR problems, workload, and distraction in routine day-to-day work leading to increased burden. Soon, a lot of requests started pouring in from services users to provide some respite and to provide help in management of patients at home. This leads to starting of Tele-Psychosocial Rehabilitation Services on October 10, 2020, as a possible solution to some of the challenges, faced by the service users. Hence, this symposium will deliberate upon the challenges that rehabilitation services had to face in the aftermath of COVID-19 pandemic and the needs that emerged thereof. Further, the symposium will propose a model of tele-psychosocial rehabilitation (T-PSR) and shed some light on its service evaluation and satisfaction of T-PSR Clinic run by MHI, GMCH, Chandigarh.
| Indian Scale for Assessment of Autism: A way Forward Development of Indian Autism Screening Questionnaire | | |
Satabdi Chakraborty, Saroj Arya, Smita N Deshpande, Triptish Bhatia, Nitin Antony
ABVIMS and Dr. RML Hospital, New Delhi, India
E-mail: [email protected]
Abstract
The Indian Scale for Assessment of Autism (ISAA) was developed by the Government of India for assessment of disability and certification of autism which is included as a certifiable disability in the Indian Rights of Persons with Disabilities Act, 2016. ISAA is a detailed instrument to assess the severity that needs trained mental health experts. Screening for autism spectrum disorder is essential in order to accelerate early treatment and interventions to improve the condition of the child. Caregiver report screening could be the best method for early identification of autism in low- and middle-income countries, due to their large populations and inadequate health-care resources. Most autism screening tools have been developed and tested in Western societies focused on infants and young children. A good screening tool should be designed in such a way so that it can be used by primary health-care workers with minimum training to identify possible at-risk individuals in the general population. There is also a need for validation of these tools in older children and adults. The utility of a screening tool depends on its sensitivity, specificity, and generalizability in the population in which it is intended to be used. The aim of this symposium is to describe the process of development of a screening tool for identification of autism.
| Youth Mental Health Innovations and Initiatives of Schizophrenia Research Foundation, Chennai, India | | |
Vijaya Raghavan, Thara Rangaswamy, Shiva Prakash Srinivasan, Sangeetha Chandrasekaran
Youth Mental Health Program, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
E-mail: [email protected]
Abstract
The Schizophrenia Research Foundation (SCARF) is working toward promoting mental health, and preventing and treating mental disorders among young people (10–24 years of age) through its Youth Mental Health (SCARF-YMH) program. We present some aspects of our YMH program.
We will provide an overview of our work with educational institutions in Chennai with the aims of (1) creating awareness about mental health; (2) networking with academic institutions and clinical settings to initiate screening, early detection, and referral; and (3) implementing a task-shifting strategy to leverage community resources to address mental health issues among youth.
The SCARF-citiesRISE (CR) program is part of the global effort of CR in many cities of the world to address and improve youth mental health. After a rapid assessment and response strategy, we designed and developed an intervention to address mental health issues among secondary school children in Chennai. This presentation will present an overview of these activities.
In order to make mental health accessible and acceptable, the YMH program at SCARF has developed a uniquely inclusive and safe space called the Resource Centre for Youth Mental Health by SCARF. This unique space located in Chennai is run by trained youth to create a nonjudgmental and supportive environment where youths discuss and learn about mental health through experiential means. We will talk about the development of this program aimed at enhancing mental health in youth.
| Innovation in Community Mental Health Training and Service Delivery: The Shifa Model and Beyond | | |
Johann Ebenezer, Praveen Mathew Alexander, Elizabeth John, Gaurav Kumar, Snehal Jayant Joshi
Christian Medical College, Vellore, Tamil Nadu, India
E-mail: [email protected]
Abstract
Topics: Introducing the dilemma: Low-resource, high-demand setting of primary care psychiatry in India – Chronic shortage of mental health specialists is a significant problem in low- and middle-income countries like India. In addition, the urban–rural disparity in distribution of services accentuates this shortage. Innovation in service delivery: The Shifa model – The Shifa model is based on a low-cost family-oriented community mental health intervention covering 75 tribal villages in rural Madhya Pradesh, India. It envisages a locally recruited nonspecialist interdisciplinary primary care team to screen, identify, and provide interventions for people with various mental health issues. Innovation in training human resources for the model: Post Graduate Diploma in Mental Health (PGDMH) – PGDMH, a 1-year blended learning program run by the Department of Distance Education, Christian Medical College, Vellore, trains MBBS doctors, who enroll as a team along with a nondoctor graduate. Created based on the Shifa model, it consists of online modules and face-to-face sessions to teach basic mental health skills for primary care. Innovation in contextualization: the Healstation experience – A team from Healstation Foundation, a nonprofit that operates in rural Bihar, India, was trained in PGDMH in order to provide community mental health services. Following the course, the team was mentored to contextualize the Shifa model for their setting, adding appropriate innovations relevant to the needs of their community.
| Social Trust and Solidarity: How It Declined and How to Rebuild It | | |
Sheila Judge, James L Griffith, Kenneth S Thompson, John H Halpern
American Association for Social Psychiatry, USA
E-mail: [email protected]
Abstract
Many national and international sociopolitical and corporate systems have been exposed as no longer able to serve their citizens with a sense of either global caring or local community function. The symposium will begin with an examination of the erosion of trust by patients in U. S. health-care systems, contributing to decreases in treatment adherence, worse outcomes, contentious treatment encounters, and declining morale for doctors and nurses, as will be illustrated in a study of physicians during the COVID-19 pandemic. Restructuring into models that treat patient care only as a business transaction is in direct contrast to healing traditions that prioritize a trustworthy doctor–patient relationship. With trust in institutions already vanishing, along came COVID-19 – a solvent for all remaining bonds. Trust and solidarity fell to new lows with misinformation, incompetence, and rising numbers of deaths, especially among racial minorities and essential workers. The resultant political unrest, racism, and resistance are playing out in the U. S. and other nations, with variable effectiveness in controlling viral spread. The speakers will utilize a number of learning methods, including presentations of historical data, clinical information, case study, and mixed-method study, to support the following conclusions and objectives: (1) a transactional model for health care poses risks for moral distress, low morale, and organizational distrust among clinicians providing health-care services; (2) sociopolitical factors play a major role in the erosion of trust and solidarity; (3) there are individual and interpersonal psychological effects of systemic distrust; and (4) the practice of social psychiatry can rebuild trust in systems. Social psychiatry brings a knowledge of how social factors and psychological well-being interact. This symposium will be proposing various specific strategies to counter the adverse effects that coalesced around COVID-19 as well as promote new paradigms not only in health care but also in supporting our responsibility to each other as social beings.
| Mental Disabilities in China | | |
Yueqin Huang, Yuntao Liu, Zhaorui Liu, Tingting Zhang
The Sixth Hospital, Peking University, Beijing, China
E-mail: [email protected]
Abstract
Background: Disabilities are a severe social and economic burden in China and other developing countries in the world. Objective: To report the prevalence of mental disabilities in China, and to provide scientific evidence for preventing mental disabilities. Methods: Using cross-sectional study method, the result of the Second National Sample Survey on Disability was analyzed. The prevalence rates of mental disabilities were statistically calculated. Descriptive epidemiology study method was used to analyze the nationwide representative date. Results: Totally, there were 2,526,145 respondents sampled in the survey. In the total respondents, 15,928 respondents were diagnosed as mental disabilities. The prevalence rate of mental disability was 6.3. The prevalence rate of mental disability without multiple disabilities was 4.7% accounting for 74.0% of all mental disabilities. Of the mental disability without multiple disabilities, there were 64.58% of disability attributable to schizophrenia, schizotypal and delusional disorders, 6.28% mood disorder, and 6.27% epilepsy disability, followed by neurotic, stress-related, and somatoform disorder (5.95%), dementia (5.19%), and other disorders disability (less than 11.74%). The disability attributable to the psychotic disorders including schizophrenia and schizotypal and delusional disorders caused the severest impairments of functions in daily and social activities, followed by disabilities attributable to dementia, nondementia organic mental disorder, and epilepsy disability. Dementia caused the severest grade of disability, constituting 44.89%. It also showed that the disabilities attributable to mood disorder and neurotic, stress-related, and somatoform disorder had more impairments among mental disabilities. Conclusion: Schizophrenia caused the most mental disabilities and dementia caused the severest disability. Meanwhile, as the main causes of mental disabilities, neurosis and anxiety disorders should be paid attention, too.
| Comorbidity and Related Factors of Mental Disability in Physically Disabled Persons in China | | |
Tingting Zhang, Zhaorui Liu, Hongguang Chen, Yueqin Huang
The Sixth Hospital, Peking University, Beijing, China
E-mail: [email protected]
Abstract
Background: Due to the long-term loss or limitation of motor function, the physical disabled may have mental problems, which will affect the quality of life of the physically disabled and their families. Objectives: To explore comorbidity and factors associated with mental disability in physical disability persons aged 15 years and over in China, so as to provide scientific evidences for prevention to multiple disabilities. Methods: Using unconditional logistic regression analysis, data of the Second National Sample Survey on Disability was analyzed to explore risk factors associated with mental disability comorbidity in physical disability. Results: The prevalence of mental disability attributed to any mental disorder in physical disability was 9.4. The comorbidity of individuals with severe disability and functional impairment were higher in physical disability comorbid with mental disability man than those in people with physical disability only and mental disability only (P < 0.05) The risk factors associated with mental disability comorbidity in persons with physical disability included female (odds ratio [OR] = 1.60, 95% confidence interval [CI]: 1.31–1.96), 30–44 (OR = 1.98, 95% CI: 1.26–3.10) and 45–59 years of age (OR = 1.69, 95% CI: 1.06–2.68), being unmarried (OR = 2.52, 95% CI: 1.85–3.44), being widowed or divorced (OR = 1.53, 95% CI: 1.20–1.95), urban (OR = 1.26, 95% CI: 1.02–1.54), and persons with severe disability (Grade I, OR = 2.30, 95% CI: 1.63–3.26; Grade II, OR = 1.76, 95% CI: 1.34–2.30; Grade III, OR = 1.43, 95% CI: 1.14–1.79). Conclusions: The comorbidity of mental disability in physical disability is higher than that in general population. Disability comorbidity aggravates degrees of disability and functional impairment of physical disability and mental disability.
| A Cross-Sectional Survey of Mental Disability Attributed to Psychosis among Persons Aged 15 Years and Over in China | | |
Rui Peng, Tingting Zhang, Zhaorui Liu, Hongguang Chen, Yueqin Huang
The Sixth Hospital, Peking University, Beijing, China
E-mail: [email protected]
Abstract
Background: Psychotic disorder is a group of serious mental disorders, and some patients have lasting functional damage. Among them, the most common type is schizophrenia, which has a chronic course and high disability rate. Objective: To describe the prevalence and characteristics of mental disability attributed to psychosis among persons aged 15 years and over in China. Methods: It was a secondary data analysis using data from the Second National Sample Survey on Disability. Prevalence of disability attributed to psychosis was the ratio of the number of disabled persons due to psychosis to the number of total population. Prevalence ratios (PRs) were estimated from Poisson regression with robust variance for the independent effects of related factors on the prevalence of mental disability attributed to psychosis. Results: The mental disability attributed to psychosis was 4.16%. Moreover, the severity of mental disability attributed to psychosis was higher than that of nonpsychosis disorders. Female (PR = 1.50), persons with older age (PRs for persons aged 30–49 years, 50–64 years, and 65 years and over were 12.78, 13.90, and 6.56 respectively), persons never married (PR = 11.74), or divorced or widowed (PR = 3.22), and people living in Western areas (PR = 1. 09) had a higher prevalence of mental disability attributed to psychosis, while persons from minority ethnic groups (PR = 0.74), finished junior high school (PR = 0.82), and population with nonagriculture household registrations (PR = 0.81) had lower prevalence. Conclusion: Attention should be paid to disability prevention and rehabilitation in Chinese adults with mental disability attributed to psychosis. Women, older persons, unstable marriage status, living in Western area, Han ethnic group, and people with agriculture household registrations should be the key population for the prevention and treatment of mental disability attributable to psychosis.
| Disability Prevalence Attributable to Autism Spectrum Disorders in China | | |
Jiana Muhai, Tingting Zhang, Zhaorui Liu, Hongguang Chen, Yueqin Huang
The Sixth Hospital, Peking University, Beijing, China
E-mail: [email protected]
Abstract
Background: Autism is almost unhealed throughout life, placing a heavy burden on patients and their families. Objectives: To descript the prevalence and distribution of disability attributable to autism spectrum disorders (ASDs) in Chinese children and adolescents, and to provide population-based evidence for disability rehabilitation. Methods: This study analyzed the data of 585,679 children and adolescents aged 2–17 years from the Second China National Sample Survey on Disability in 2006. Descriptive epidemiological methods were used to describe the rate of disability attributable to loneliness and its population and regional distribution in China. Results: There were 124 children and adolescents diagnosed as disability attributable to ASD, in which 17 in 2–3 age group, 46 in 4–6 age group, and 61 in 7–17 age group. The prevalence of disability attributable to ASD in children and adolescents was 2.12 per 10,000 people, and the prevalence rates in children aged 2–3, 4–6, and 7–17 were 1.92, 5.45, and 1.48 per 10,000 people, respectively. The prevalence of disability in males was significantly higher than that in females (2.81/10,000 vs. 1.48/10,000, P < 0.001), and there was no significant difference between the prevalence rates in rural and urban areas (2.11/10,000 vs. 2.13/10,000, P > 0.05). Meanwhile, there was no significant difference in various nationalities of China. The proportion of disability attributable to SAD was 11.8% among metal disabilities aged 2–17. Respectively, 22.1% and 22.4% of mental disabled children aged 2–3 and 4–6 were attributed to ASD. Conclusions: ASD makes one of the major contributions to mental disability in preschool children in China, and should be paid more attention to.
| Distribution of Disability Attributable to Mental and Behavioral Disorders due to Psychoactive Substance in China | | |
Peilin Xu, Tingting Zhang, Zhaorui Liu, Hongguang Chen, Yueqin Huang
The Sixth Hospital, Peking University, Beijing, China
E-mail: [email protected]
Abstract
Background: The abuse of psychoactive substances in society is becoming more and more prominent, and it will not only cause serious physical and mental damage but also cause a series of family and social problems. Objective: In order to provide evidence for making strategy and measurement related to disability rehabilitation, prevalence of disability attributable to mental and behavioral disorders due to psychoactive substance and its distribution was analyzed. Methods: Using descriptive epidemiological method, the data of the Second National Sampling Survey on Disability in 2006 were analyzed to show prevalence rate of disability attributable to mental and behavioral disorders due to psychoactive substance and its distribution by population and region, and severity of the disability. Results: The prevalence rate of disability attributable to mental and behavioral disorders due to psychoactive substance was 0.17%. The prevalence rate in males was 15.5 times higher than that in females. The prevalence rate in the divorced was 7.1 times higher than that in the married. The prevalence rate in the unemployed was 1.8 times higher than that in the employed. The prevalence rate in the illiterate was 3.7 times higher than that in high school and higher education levels. Among the disabled attributable to mental and behavioral disorders due to psychoactive substance, proportions of mild, moderate, severe, and extremely severe of psychiatric disability accounted for 74.2%, 11.5%, 9.2%, and 5.0%, respectively. There were 357 disabled people without multiple disabilities of 33.3% who had severe and extremely severe impairments in function of daily activities. Conclusion: Prevalence rates of disability attributable to mental and behavioral disorders due to psychoactive substance vary greatly in population and regions. The disabled may have the severest impairments in daily activities among all kinds of function.
| Psychosocial Consequences of Excessive Internet Use among Children and Adolescents during COVID-19: A Real Concern | | |
Dipanjan Bhattacharjee, Prasad Kannnekanti, Varun S Mehta, J W James
Central Institute of Psychiatry, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Outbreak of COVID-19 pandemic has affected school-going children and adolescents very dearly. Governments had to take stringent decisions such as “lockdown,” “public movement restrictions,” and “closure of institutions, offices, and schools” to control the pandemic. In order to continue the academic activities, educational institutions had to adopt online modes of communication. Due to the pandemic, many of our children and adolescents are spending their time in front of the screen, because of their online academic schedules and lack of outdoor activities. The Internet has become an essential part and parcel of modern life, and it is impossible to envision even a single day without it. Childhood and adolescence are essential in each ones' life, but apart from the academic activities, children and adolescents are using online gaming, social networking, shopping, gambling, pornography, etc. They are highly vulnerable to Internet dependence, problematic Internet use, compulsive Internet use, etc. Globalization has been made easy through the Internet, but the scientific community has also started looking at the challenges of excessive Internet use. The COVID-19 pandemic has disrupted the normal routine of children and adolescents; stay at home has become an alternative to all their everyday interactions, including classes, assignments, and celebrations. Schoolchildren and adolescents are compelled to use online platform and means to keep pace with their academics, but the excessive usage of this medium is making them vulnerable for developing Internet addictions as well as psychological problems. Those issues are to be dealt professionally to make this segment of the population less vulnerable and how to ensure judicious use of this medium for their betterment.
| Child Abuse – A Pandemic within a Pandemic | | |
Indira Bhowmick, Amrita Sahay, Satabdi Chakraborty
ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India
E-mail: [email protected]
Abstract
Children are usually considered a vulnerable group during any crisis situation in developing countries. Two consecutive waves of COVID-19 have a spiraling effect on children in India. An alarming rise in child abuse cases indicates the increase rate of evidence that the novel coronavirus pandemic has a serious impact on children. According to the WHO report, the schools were closed to 1.5 billion children worldwide because of the pandemic, and the parents face a high level of stress and anxiety from insecure job, loss in income, social isolation, and potential crowding in the home. During this new practice, children become easy targets for their family members as well and they could not even vent out their frustration. In addition, investing more time in the virtual world may expose children to an increased risk of online sexual exploitation or bullying. One of the most hurtful outcomes within the household for children has been a surge in sexual abuse cases. These incidents are seen such as shame-filled concepts as families and even the children are reluctant to report or pursue a case for further investigations. In the context of the child protection risks and adversity in childhood, the actual mental health issues of the child tend to be overlooked in such emergency. This symposium aims at discussing the psychological impact of child abuse during the COVID-19 pandemic and its consequences on children and describing the legal aspects of child protection and psychosocial risks they are to be found during and in the immediate aftermath of the COVID-19 pandemic and its lockdown situation.
| Biopsychosocial Underpinnings of Gender Discrepancies in Organ Donation: The East versus the West | | |
Jigyansa Ipsita Pattnaik, Susanta Kumar Padhy, Vikas Menon
St Johns Medical College, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
The United Nations Organ System (UNOS) and the Eurotransplant (ET) system reported that over 60% of the transplanted patients were males (Melk et al., 2019). The waiting list of 103,156 patients in the UNOS and 11,105 in the ET had 61% of males each. Data from the UK, Europe, and Italy show a preponderance of women donors. In the US also, women outnumbered men in living kidney donors, whereas men being more often the recipients. Gender inequity in accessing medical treatment is a global issue. This bias is particularly highlighted in organ transplantation; whereas women constitute majority of living kidney donors, they receive fewer live kidney transplants compared to men. In India, the difference is even more stark; women constituted less than a third of living organ recipients in 2019 but more than three-quarters of living donors (both related and unrelated) (Malattiri et al., 2014). Data from the National Organ Transplantation and Tissue Organization show that majority of living donors are women and organ recipients are men. Among organ transplant recipients, there are 23,682 men and a meager 5025 females. Thus, gender disparity exists irrespective of whether the country is developed or developing. This is a serious ethical and public health issue, particularly in India, where females are at a disadvantageous position among all sociocultural-political realms. Firstly, the economic implications – where, men being the sole breadwinners mostly, the financial implications of being indisposed for weeks following organ donation would serve as a deterrent for men to donate. Secondly, women, in general, have a greater sense of responsibility and self-sacrifice than men. Indian women see caring for their family as an extension of their domestic duties and are more likely than men to volunteer to donate during a family crisis. A deeper understanding of the psychosocial milieu, with specific roles attributed to women, particularly in India, is thus, imperative.
| Operationalization and Implementation of Nationwide Online Training Workshop on Statistical Analysis in Mental Health: Opportunities and Challenges | | |
Ashwani Kumar Mishra, Pratibha Singh, Saumya Dwivedi
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]
Abstract
Background: The medical residents face challenges in the judicious application of appropriate analytical approaches for the data and statistical analysis. Except for premier medical institutions, formal exposure to the teaching of medical statistics is lacking. With the availability of the online platform for educational activities, practical ways for capacity-building measures on the statistical techniques are also feasible. Hence, an Online Nationwide workshop on Analytical Techniques for Statistical Analysis in Mental Health was organized. Objective: The present deliberation aims to sensitize the audience on the strategies adopted for planning and implementing this nationwide workshop purely in the virtual world. Methods: The workshop involved a combination of didactic lectures and practical hands-on sessions on relevant topics such as research methodology, newer aspects of research in mental health, analysis (qualitative, quantitative, categorical, and longitudinal), correlation and regression, longitudinal data analysis, and systematic review and meta-analysis. Results: The organizational activities were planned systematically which enabled in achieving a total of 654 participants. A total of 284 (43.4%) were professionals from mental health. More than three-fourth (83.6%) got a chance for attending such a workshop for the first time. The profile of registered participants was also found to be quite diverse (faculty – 22%, Ph. D. scholars – 22%, junior residents – 8%, senior residents – 5%, statisticians – 8%, and epidemiologists – 8%). The program was well received. Conclusion: The sensitization of planning activities regarding practical difficulties and steps to overcome them will probably help educationalists and trainers to derive replicable and scalable models of statistical education in mental health.
| Suicide is a Societal, Not a Mental Health or Even a Public Health Problem: For and Against Debate | | |
Digvijay Goel, Alok Sarin
Southland Hospital, Invercargill, New Zealand
E-mail: [email protected]
Abstract
Background: Suicide is a significant cause of mortality and is regarded as a major public health problem. It is also considered to be preventable. Perhaps for that reason, suicides evoke a sense of moral outrage. This in turn triggers a blame game. Something must have gone wrong. Someone must have failed. Someone must be held accountable. Mental health professionals are often held guilty by default and “the suicide prevention plans are regularly rolled out mental health services are broken” is a frequently heard lament. This in turn leads to the inevitable political fallout, with leaders calling for a “zero suicide” policy. Elaborate and expensive suicide prevention programs are regularly rolled out, almost inevitably with contrary outcomes. In New Zealand, for instance, suicide rates have increased with each 4-year plan and the country now has the highest teenage suicide rate in the world. Objectives: To examine suicide from a fresh perspective and identify the reasons why suicide prevention programs fail. Are we applying the wrong remedy at the wrong place? Being health professionals, have we fallen into the trap of viewing a wider societal problem through the mental and public health prism? Do we need a radical shift in focus? Methods: A for and against debate on the motion, “suicide is a societal, not a mental health or even a public health problem.” The house will vote before and after the debate to evaluate whether their views have been swayed one way or another by the arguments presented. Results: Results will be determined by the audience on the basis of the evidence presented by the two speakers. Conclusions: To be summed up by the chairperson though, it will be for the audience to come to their own conclusions based on the arguments advanced in favor and against the motion.
| Psychological Autopsy Research: Past, Present, and Future | | |
Roshan Sutar, Vijender Singh, Ashish Pakhre, Akash Kumar
AIIMS, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
A substantial number of suicides are reported across the world. The rate of suicides in India per lakh population stands at 16.3, with a global average of 10.6. Various modifiable risk factors have been identified through psychological autopsy (PA) research to reduce the suicide rates globally. PA remains a unique inquiry into the cause of death, but the studies involving PA have witnessed inherent methodological issues. Further, PA studies have transformed from observational to case–control often referred to as from first generation to second generation in the past two decades. Often, PA remains the sole method of inquiry for investigation of suicide, therefore, the early career researchers interested in this area should be acquainted with associated advantages and challenges. Further to develop a uniform suicide prevention policy, PA remains a fundamental investigative tool to identify the established and evolving risk factors and replicate the results. Recent attempts have been made to bridge the gaps in methodology between west and east, however, challenges in maintaining the efficient suicide registry in India have partially contributed to an inadequate amount of research in this area. For a group of social psychiatrists, to plan a nationwide PA study thus remains a far-fetching challenge. Moreover, add-on technology could broaden the horizon of PA studies. Social isolation is identified risk factor for suicide, and the current unfolding of the pandemic has probably unearthed the importance of digital phenotypes in the prevention of mental health problems. Can a conventional PA be complemented with formal artificial intelligence-assisted digital phenotypes and biological markers remain to be explored in near future? The symposium would bring newer insights into the birth of PA research, the evolution of PA studies, identification of proximal and distal risk factors of suicide, research gaps of east and west concerning India, and future research prospects on PA.
| Obsessive–Compulsive Disorder: Enigma Wrapped in a Riddle | | |
Digvijay Goel, Agata Golawska Moody, Pratap Kovvuri, Alexandra Antczak
Southland Hospital, Invercargill, New Zealand
E-mail: [email protected]
Abstract
Background: Described as the “hidden epidemic,” obsessive–compulsive disorder (OCD) is perhaps one of the most ubiquitous, yet underdiagnosed and undertreated, mental health disorders. Lifetime prevalence is estimated at around 2%–3%, but together with comorbidities and regional variations, OCD probably contributes a relatively higher proportion of the global burden of disease. Objective: To interrogate the many facets of this complex, often difficult to treat and as yet inadequately understood disorder. Methods: Multipronged analysis of issues around epidemiology, etiology, diagnosis, and treatment by a panel of speakers. Results: The diagnostic spectrum has been amplified in the Diagnostic and Statistical Manual of Mental Disorders-5 to include a body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation, now classified as “OCD and related disorders.” The International Classification of Diseases-11 adds hypochondriasis, olfactory reference syndrome, and Tourette syndrome to the basket. This adds to greater heterogeneity and renders the epidemiologic, phenomenological, etiological, neurobiological, and therapeutic conundrum even more complex. While recent genetic and molecular research has helped unravel some of the underlying neurobiological mechanisms underlying, many areas of darkness remain. Genome-wide association studies reveal a close correlation between OCD and anorexia nervosa. Gene–environment interactions encompass adverse perinatal and other traumatic events, underlining the need for further inquiry. While several brain regions and neuronal circuits have been implicated, most are yet to be credibly validated. A variety of interventions from cognitive behavioral therapy, through numerous psychopharmacological agents, to neurosurgery (including DBS) have been trialed, and several treatment algorithms formulated. Alternative modalities such as yoga and acupuncture have been found to be helpful in a subset of patients, but for many, the quality of life remains compromised even after a long and often arduous therapeutic journey. Conclusion: This veritable “enigma wrapped in a riddle” continues to pose a Byzantine challenge to researchers and clinicians alike. Innovative thinking is needed to identify what works for whom.
[TAG:2]Old Age, Population Aging, and Older Persons through the Lens of Human Rights and Social Psychiatry: A Joint World Association of Social Psychiatry–Section of Old Age Psychiatry (World Psychiatric Association)–World Federation for Mental Health Symposium[/TAG:2]
Debanjan Banerjee, Roy Abraham Kalliyavayalil, Carlos de Mendonça Lima, Gabriel Ivbijaro
E-mail: [email protected]
Abstract
Population aging is one of the predominant public health concerns. The number of individuals above 60 years worldwide is estimated to triple by 2050. Comprehensive geriatric assessment, an evidence-based holistic health-care approach for the older persons, highlights the need for socioecological considerations in geriatric care. With the rising burden of psychiatric morbidity and dementia prevalence that accompany population aging, psychogeriatric care needs to be geared beyond the “medical” and “categorical” lens toward a dignity and human rights-based approach. The field of social psychiatry is uniquely equipped with the research, understanding, and implementation of these social determinants of psychogeriatric practice. With the ongoing plight of the coronavirus disease 2019 pandemic, the marginalization and rights deprivation of older persons have once again come to the forefront, which are predispositions to the psychosocial morbidity in this vulnerable population for years to come. The social dimensions of aging have received an all-new impetus with the recent controversy related to the classification of “old age” under “general symptoms” and “causality” in the International Classification of Diseases (ICD)-11. Discrimination based on age can lead to catastrophic social consequences such as elder abuse, agism, and stigma. Intersecting across psychiatric diagnoses and interventions are the principles of dignity, autonomy, respect, and equality which are also reflected in the United Nations Convention on the Rights of Older Persons. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. Keeping in mind these intersections between social psychiatry, sociology of aging, and psychogeriatrics, this symposium is a joint collaboration between three global mental health bodies, the World Association of Social Psychiatry, the Section of Old Age Psychiatry (SOAP)–World Psychiatric Association (WPA) and the World Federation for Mental Health (WFMH). The speakers will highlight the following dimensions advocating the need for a biopsychosocial and rights-inclusive model for old age mental health care:
| Mahatma Gandhi: An Ambassador of Mental Health | | |
Gulbahar Singh Sidhu, Deepali Gul, Gurvinder Pal Singh
Doaba Hospital, Jalandhar, Punjab, India
E-mail: [email protected]
Abstract
Mahatma Gandhi figures prominently in the curricula of Indian schools. The History textbooks reel off the public movements initiated and led by him against the Imperial British Government as well as the nonviolent means espoused by him. However, the Mahatma goes far beyond these historical facts. Gandhian way of life, in fact, has relevance even today, especially with respect to community mental health. Speaker 1 would set the backdrop by outlining the facets of Gandhian way of life including discipline, empathy, resilience, and altruism. Speaker 2 would discuss the relevance of Gandhian thought and way of life with respect to mental health of the individual as well as the community at large. Speaker 3 would highlight the paradox of the relevance of Gandhian philosophy and it being overlooked in the literature relating to mental health and argue whether Mahatma Gandhi continues to be a true ambassador of mental health.
| Challenges in Parenting during COVID Times | | |
Manoj Sahoo, B N Subodh, Harshita Biswas
Tata Main Hospital, Jamshedpur, Jharkhand, India
E-mail: [email protected]
Abstract
Speaker 1: Introduction to Parenting-the challenges and way out during COVID times – As the COVID-19 crisis spreads around the world, it is transforming children's day-to-day lives. The children and the adolescents are now subjected to many changes, like being in isolation to online classes. In this part, the speaker will discuss the understanding of different styles of parenting, basics of good parenting, challenges that are been faced by parents in managing the child or adolescents during COVID times, and the various techniques and tips on how parents can handle the child during the pandemic situation. Speaker 2: Parenting children with special needs during COVID times – The COVID-19 outbreak has introduced significant stress and disruption to the lives of children with special needs and their caregivers. COVID-19 is disrupting their access to therapeutic supports. Such children and their parents would now need further help to build and maintain new routines and learn new effective coping skills. However, most families lack guidance and information, thus leading to parental stress. In this part, the speaker will discuss what are the challenges the parents and children with special needs are facing, how to manage the special needs of child and parental stress. Speaker 3: Parenting children with Substance and behavioral addictions – Pandemic-related stress, anxiety, and isolation, in addition to disrupted lifestyles, can increase the likelihood of addiction and substance misuse. An increase in free and alone time, uncertainty of future, and the absence of any engagement for adolescents and young adults has repercussions that can lead them to seek ongoing solace from substance abuse and behavioral addictions. In this part, the speaker will discuss about rise in addiction behaviors, that challenges the parents are facing with children of behavioral and substance addiction and focus on parental management of such behaviors.
| Music in Mental Health | | |
Hitesh Khurana, Vishal Dhiman, Sai Krishna Tikka
Institute of Mental Health, PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: The therapeutic potential of music is not well known to many clinicians and musicians. Any kind of musical activity such as listening and playing has beneficial effects on mental health. Objectives: The symposium highlights the neurobiology, clinical implications, and cultural aspects related to therapeutic use of music in mental health. Methods: The symposium has three topics as follows: Physiological bases of Musical Healing (Speaker: Sai Krishna Tikka) – There is hardly any part of the brain or neurochemical that is not involved in musical activities. In this section, the author (SKT) would discuss the complex neuronal mechanisms associated with different musical activities with the aim to highlight physiological and neurochemical basis for using music for promoting well-being and treating mental health conditions. Clinical uses of music (Speaker: Vishal Dhiman) – Music has been found useful in ameliorating mild mental health conditions such as anxiety to severe disorders such as Alzheimer's disease and autism. In this section, the author (VD) would critically review the evidence from methodologically strong studies about effectiveness and efficacy of music in various mental health conditions. Music therapy in India (Speaker: Hitesh Khurana) – Music had been used for therapeutics in ancient India, but it gradually became less popular. Just the number of different musical traditions and genres being practiced in India itself speaks of the potential of music therapy in India. Here, the author (HK) discusses the Indian view of music therapy in the current times. Results: Music is an unambiguous scientific ground for its use in mental health-related issues. Conclusion: There is a need to popularize the use of music for mental health interventions.
| Spirituality and Mental Health | | |
Anju Dhawan, Kishore Chandiramani, Divya Kanchibotla
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Spirituality and Mental Health – Background – Dr. Anju Dhawan, AIIMS Delhi: Spirituality has been defined using various constructs and measured with different instruments. It has been documented to play a role as a protective factor in mental health and to be associated with better coping, reduced rates of anxiety, depression, and suicide. Exploring spiritual beliefs and involvement is often missed in mental health assessments. Guidelines suggest that based on the patients' belief systems, values, and practices, these aspects should also be integrated into mental health intervention, while paying due attention to ethical aspects and clinical boundaries. Studies that assessed incorporating spiritual aspects into treatment have found these to be beneficial. Discussing Spiritual Values in Therapy Sessions – Dr. Kishore Chandiramani, Consultant Psychiatrist, UK: The mind can be understood in terms of two broad categories in the spiritual field – the intellect, the thinking/judging/feeling/reacting part of the mind and the inner consciousness, which is the nonjudging, nonreacting, emotionally neutral consciousness. The goal of practicing spiritual values is to stop identifying with the intellect and to connect with our inner consciousness which is free from suffering. The author has developed a way of discussing spiritual values in therapy sessions in a way that can make sense from psychological point of view so that these are easily accepted even by clients who are not spiritually minded. Community Experience – Dr. Divya Kanchibotla, Sri Sri Institute of Advanced Research, Bengaluru: Spiritual interventions have been widely used as a part of yoga and meditation practice in India. The Art of Living Foundation has documented the benefits of meditation and Sudarshan Kriya Yoga, a rhythmical breathing process. Several studies on SKY have shown its impact on emotional and social health. The effect of SKY and meditation in alleviating depression, anxiety including posttraumatic stress disorder has been studied in diverse populations. These practices have been used to improve the mental health of students, war veterans, prisoners, and people afflicted by disasters. Randomized controlled trials have also been conducted, and some of the findings will be shared.
| Technologically Empowered Primary Care Psychiatry Program: A Multicentric Collaboration of Public Health Importance | | |
Narayana Manjunatha, Suresh Bada Math, C Naveen Kumar, Ravi Gupta, Pankaj Kumar
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Narayana Manjunatha: PCPP: Design the curriculum, validation, and implementation – The digitally driven, modular-based, part-time, specialized primary care psychiatry program has been designed and implemented across various states (Uttarakhand, Bihar, Karnataka, etc.) of India to perfect psychiatric integration care by primary care doctors. A 1-year prototype course, Diploma in Primary Care Psychiatry, begins for practicing MBBS doctors with a validated point of care manual named “Clinical Schedules for Primary Care Psychiatry.” PCPP is also extended to paramedical professionals such as nurses, accredited social health activist workers, and pharmacists. Suresh Bada Math: “Reaching the unreached” using telepsychiatry – Reaching the unreached was an attractive slogan for public health policy during the 20th century. He will be sharing how the technological revolution has changed the landscape during the 21st century. C Naveen Kumar: Multicentric collaboration: Need, benefits, and the process of implementation – He would be sharing from his firsthand experience on the need, benefits, and process of implementation of multicentric academic and organizational collaboration. Ravi Gupta: Sharing experience NIMHANS & AIIMS-R collaboration – He would be sharing his firsthand experience of opportunities and challenges of collaborative work from his academic center. Pankaj Kumar: Beginning of new partnership and plan – He will be sharing his perspective from a new national academic institute about the plan of multicentric collaboration of public health importance.
| Development and Well-Being of the Children and Adolescents in New Digitalized World | | |
Pawan Kumar Gupta, Vivek Agarwal, Amit Arya
King George's Medical University, Lucknow, Uttar Pradesh, India
E-mail: [email protected]
Abstract
With the increased use of the Internet, the social media has become an integral part of our daily life and is transforming our social milieu multifariously. Social media not only facilitates personal and social communication but also caters domains such as online shopping, news, blogging, and dating forum. Exposure to the Internet may start very early in a child's life, for instance, using smartphones as pacifiers for infants. Children have become avid users of online forums, chat rooms, messaging, social media, and online games. The negative aspects of excessive Internet use and social media are coming up in the form of diverse cyberpsychiatric disorders and related conditions. These conditions encompass newer entities such as gaming disorders or presentations such as cyberchondria and cyberstalking and cyberbullying and also influence psychiatric conditions such as ADHD, conduct disorders, depression, and anxiety disorders. Hence, it becomes important to understand how the use of the Internet and social media is influencing psychosocial development and well-being of a child. This understanding will help to identify key influences, critical stages in development, and long-term manifestations in behaviors and psychopathologies. In this symposium, we shall try to shed light on developmental perspectives of the use of the Internet and social media based on available literature and initiate a discussion about possible models of studying this area.
| Behavioral Sciences in UG Curriculum | | |
Ravi Gupta, Anindya Das, Vijay Krishnan, H R Vinay, Anil Nischal
AIIMS, Rishikesh, Uttarakhand, India
E-mail: [email protected]
Abstract
Behavioral science, especially psychiatry, is an important area that needs to be included in the undergraduate medical curriculum. However, despite best efforts, at least in India, psychiatry is still a small section of general medicine training for medical graduates. It happens despite the fact that prevalence of psychiatric disorders is greater than many other medical disorders that have been included in curriculum. Recently, All India Institute of Medical Sciences, Rishikesh, has taken the initiative to make psychiatry as a major subject during medical graduation. However, to maintain the uniformity of transcript across country, it is still shown as part of general medicine, however, to maintain the importance of subject, it is mandatory that medical graduates secure at least passing marks in psychiatry. Another important issue is identifying the must-know areas in psychiatry for medical graduate as he is already burdened with a number of other subjects. Whether having psychiatry as a separate subject further burdens the medical graduates, and how to deal with this situation is still open to debate. Understanding of psychiatry has changed over years and as of today psychiatric disorders are understood as brain disorders. Dealing with this issue is further challenging in view of constantly changing concepts of neurobiological basis of psychiatric disorders, though it may attract medical graduates to discipline. Finally, sleep disorders are common in general as well as psychiatry practice and prevalence of some of the sleep disorders is much higher than that of psychiatric disorders. Moreover, sleep disorders can often be mistaken for psychiatric disorders. Hence, they should be included during psychiatry training to medical graduates.
| Domestic Violence: Response and Remedies to the “Shadow Pandemic” | | |
Indira Bhowmick, Satabdi Chakraborty, Sunita Kumari
ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India
E-mail: [email protected]
Abstract
Domestic violence (DV) is a widespread problem in India; saw an enhanced rate since the first lockdown imposed in India to restrict the spread of COVID-19. There are multiple evidences to conclude that DV during the COVID-19 pandemic increased globally. The limitations imposed to control the spread of virus resulted in an increase in violence. The global increased rate of DV cases during this pandemic, often being quoted as the “double pandemic,” “shadow pandemic,” “hidden epidemic,” and “the other pandemic” (UN-Women Report, 2020). The pandemic has already created anxiety among people leading to fear, financial insecurity, due to loss of a job, etc. It has own behavioral and psychological manifestation and may lead to stress, altercations, fight, conflict, anger, and violence. Besides, the lockdown has increased the burden on women which is also high as many of them have to cook, feed, and take care of household chores and family members who are at home. Women in abusive relationships possibly are more likely to be exposed to hostility, violence, also their children as well. It needs to understand the reason and dynamics of such violence, considering that men and women both are engaged in such violence against each other and bear its consequences together.
| Rehabilitation for Persons with Psychiatric Disabilities during COVID-19 Pandemic: Practical Experience from Indian Tertiary Care Center | | |
Thanapal Sivakumar, Krishna Prasad M, Hareesh Angothu, Sujai R, Amrita Roy
National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Worldwide, the COVID-19 pandemic has led to uncertainties about its spread, effectiveness of containment strategies, and when life will return to normalcy. COVID-19 has worsened health care for persons with psychiatric disability (including mental illness and developmental disability) and accelerated technology adoption to replace disrupted in-person mental health services when possible. Rehabilitation is a necessary but often neglected part of the comprehensive management of persons with psychiatric disabilities. Psychiatric NIMHANS offers psychiatric rehabilitation services in outpatient, daycare, inpatient, inpatient referral, and community settings. Persons with psychiatric disability are helped with disability certification, accessing welfare benefits, vocational training, job placement, offered education inputs, and respite care. Monthly caregiver support and training programs are conducted. In this symposium, we shall discuss the practical experience of ensuring continuity of rehabilitation from an Indian tertiary care center during the pandemic.
| Challenges in Conducting Research during COVID-19 Pandemic | | |
Rakesh K Chadda, Mamta Sood, Tulika Shuklsa, Shivali Agarwal, Jasmine Bhogal
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
COVID-19 pandemic is an extraordinary event that has impacted clinical care, training, and research. Traditionally, the research in mental health requires detailed assessment, application of scales, or conducting interviews to the participants and sometimes also investigations. All these research activities are usually conducted in person. Complete and partial lockdowns and physical distancing measures have posed many challenges in conducting research. During the pandemic, challenges have been observed in many activities related to conducting research. Because of scaling down or temporary closure of non-COVID services, it is not possible to collect data in person. The COVID-19-related lockdown has also decreased the accessibility to research participants. In this background, online mode of data collection is most feasible. There have been antecedents of conducting research online, but largely, these have been surveys. There are no clear guidelines on conducting research online. The difficulties can be in methodological aspects such as sampling strategies, conduct of assessment online, in ethical aspects such as taking informed consent and in publication-related processes. Furthermore, there may be delay in getting expedited ethical clearance for conducting research. In mental health research, especially in qualitative research, it is difficult to collect nonverbal data interpreted usually by facial expression because of the masks. Many strategies and guidelines have been proposed to handle these issues. The researchers can approach research funding agencies and ethics committees for permission to revise study protocols to allow for data collection using online platforms. The journals can encourage the researchers from diverse settings for including in the research article impact of COVID-19 pandemic and interventions implemented to address these issues. There is a need for novel and innovative research approaches to continue research during the challenging times of COVID-19 pandemic. In this symposium, we will discuss the impact of COVID-19 pandemic on research.
| Development of Mobile Apps – Saksham and Disha for Persons with Psychosis | | |
Mamta Sood, Pushpendra Singh, Koushik Sinha Deb, Nishtha Chawla
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Psychotic disorders result in significant disability and burden. Psychosocial interventions along with pharmacotherapy help improve the functioning of persons with psychotic disorders. Mobile apps have been developed for persons with psychosis in high-income countries. These may not be applicable for persons residing in low-resource settings as psychosocial interventions are mostly provided by the family members. In the last few years, there has been a rapid spread of mobile phone networks in low-resource settings. Research shows that persons with psychotic disorders residing in these settings use mobile phones. Over this background, we collaborated with computer engineers to develop mobile apps for persons with psychotic disorders. Prior to developing the app, the needs of service users (patients and caregivers) and perspectives of service providers (mental health professionals) were assessed using focused group discussions. Based on the findings, it was decided that we the mobile app should also have a component of inclusion of caregivers. Furthermore, these findings guided the content and functions of app. The engineers were then involved in the process of developing the app. The app development and refinement required to-and-fro passing and processing of information from the two sets of professionals. Different technical glitches which occurred during development required time to be understood and corrected. Certain features were changed after pilot testing on patients of psychosis. The major challenge included lack of technical understanding by the clinicians and lack of medical knowledge by the engineers. App named “Saksham” (meaning capable) was developed for patients with established psychosis and “Disha” (meaning direction) was developed for patients with first-episode psychosis.
| Partnering and Innovating for Better Access to Mental Health Care | | |
| Fight Against Stigma Program: Key Outcomes and Learnings from a 14-Year Long Partnership | | |
Driss Moussaoui1, Pierre-Emile Bruand2, Rachid Bennegadi3, Farid Boumédiène4, Pierre-Marie Preux4
1World Association of Social Psychiatry, Casablanca, Morocco, 2Global Health, Sanofi, Gentilly, 3World Association of Social Psychiatry, Sigmund Freud University, Paris, 4INSERM, University of Limoges, CHU Limoges, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
Abstract
Background: Despite a significant impact, mental and neurological disorders remain among the most neglected areas of Global Health. Over 75% of people with mental disorders or epilepsy in low- and middle-income countries (LMICs) are not treated, according to the WHO. The main barriers to mental health and epilepsy care in LMICs include the shortage of specialized workforce, the inadequate training of primary care workers, and the traditional beliefs and prejudices regarding these diseases, which often lead to stigmatization and discrimination. Methods: For 14 years, the World Association of Social Psychiatry, the Institute of Epidemiology and Tropical Neurology (UMR 1094 Inserm), and Sanofi Global Health have joined forces to promote better access to care for people with mental disorders and epilepsy, and to develop and test community-based interventions to reduce the treatment gap in LMICs. This is known as the Fight Against Stigma Program and is based on training primary health-care workers to identify and manage people with mental disorders and epilepsy, raising public awareness, educating and supporting patients and their families. These initiatives are designed and implemented with local stakeholders from LMICs from diverse backgrounds (health authorities, experts, health-care professionals, nongovernmental organizations, patient associations, etc.). Results: Through this unique partnership between a professional association, academia, and a pharmaceutical company, a strong international network has been built across several LMICs and initiatives have been launched in over 20 countries. To date, it is estimated that over 10,700 health-care workers have been trained, over 3.4 million people have been reached through awareness and educational activities, and over 133,000 people with mental illness or epilepsy have been diagnosed and/or treated. Conclusions: By promoting a greater understanding of the issues at stake, this partnership also aims to empower local stakeholders to drive policy change in their country for better access to mental health and epilepsy care.
| Greater Access to Mental Health Training via E-learning: A Pilot in Mali | | |
Amy Fall-Ndao1, Pierre-Emile Bruand2,3, Oumar Poudiougou4, Line Kleinebreil5, Driss Moussaoui6
1Global Health Medical Lead for Africa, Sanofi, 2Global Health, Sanofi, Dakar, Senegal, 3Global Health, Sanofi, Gentilly, France, 4Santé Sud, Bamako, Mali, 5???, Université Numérique Francophone Mondiale, Paris, France, 6World Association of Social Psychiatry, Casablanca, Morocco
Abstract
Background: Despite their high prevalence and significant burden, mental disorders remain grossly underdiagnosed and undertreated. In low- and-middle-income countries (LMICs), such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. This E-learning pilot follows a successful capacity building initiative in Mali which through face-to-face training of rural general practitioners (GPs) demonstrated significant improvements in mental health knowledge, attitudes, and practices and resulted in better mental health care for patients in these rural areas. Objectives: The aim of this pilot is to test an E-learning platform to provide access to mental health training to a greater number of health-care professionals in remote areas in Mali. Methods: A 15-h training program including 12 modules was developed based on materials previously used in LMICs and reviewed by the World Association of Social Psychiatry. A digital agency designed the modules, integrating voiceover and quizzes, to make them interactive and engaging. The Université Numérique Francophone Mondiale built the Learning Management System with pre- and posttraining questionnaires to assess learners' progress and the effect of the training. Live webinars with a psychiatrist have also been organized. Results: After 4 months, 81.5% of the 54 registered GPs have completed at least one module, and 48% have completed all 12. On an average, improvements in knowledge and practices scores ranged between +9% and +20%, depending on the module. The average score regarding satisfaction about their knowledge and confidence in diagnosing and managing patients with mental disorders went from 4.98 before the training to 8.29 after (+66%). Conclusion: Despite the difficult conditions of this pilot in isolated areas of rural Mali, including limited Internet access, preliminary results suggest a positive effect of the E-learning. This program is being rolled out in Senegal and would be a useful tool for French-speaking countries and LMICs.
| South Africa: A Brief Training Intervention for Health Workers to Improve Mental Health Service Delivery | | |
Frances Slaven1, Yvonne Erasmus2, Margot Uys1, Pierre-Emile Bruand3, Beki Magazi4, Rabia Wadvalla5
1Foundation for Professional Development, Pretoria, 2Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa, 3Global Health, Sanofi, France, 4Sanofi South Africa, 5University of KwaZulu-Natal, South Africa
Abstract
Background: South Africa faces a number of significant challenges with regard to mental health service delivery, including a large treatment gap, a high rate of readmission, overburdened specialist tertiary facilities, and slow integration of mental health into general health services. A short training program was implemented to upskill medical officers and professional nurses working at primary and secondary care levels to diagnose and manage mental disorders. A total of 1120 health-care workers were trained between February and December 2019. Objectives: The objectives of the study were to: (1) assess training participants' self-reported competency in mental health care before and after the training; (2) determine if there was a decrease in the number of self-reported mental health referrals to higher levels of care; and (3) describe the training participants' overall experience of the training. Methods: Data were collected from training participants through a pre- and postcourse survey, and a 3-month follow-up survey. Results: The overall average confidence ratings for performing mental health-care activities and managing mental health conditions increased from pre- to postcourse and were either maintained or increased further at 3-month follow-up. At 3-month follow-up, there was a decrease in the self-reported percentage of patients referred to a higher level of care. Conclusions: If health-care workers in primary and secondary care are better equipped to manage mental health patients, there will be less need to refer patients to higher levels of care which may reduce the risk of relapse and subsequent need for re-admission, thereby contributing to the easing of the revolving door syndrome. The evaluation suggests that a brief training intervention such as a short course can go a long way in increasing the confidence of primary and secondary level health-care workers in managing common mental health conditions and adhering to the provisions of legislation.
| Myanmar: Empowering Health Workers and Leveraging Digital Technology to Improve Access to Mental Health Care in Hlaing Thar Yar Township | | |
Khin Maung Gyee1, Lara Mroueh2, Farid Boumédiène2, Pierre-Emile Bruand3, Pierre-Marie Preux2
1Myanmar Medical Association, Yangon, Myanmar, 2INSERM, IRD, Univ Limoges, CHU Limoges, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, Limoges, 3Global Health Programs, Sanofi, Paris, France
Abstract
Background: Despite an estimated 8% prevalence for mental disorders in Myanmar, the treatment gap is high, up to 90%. Only 0.4% of the total health budget is spent on mental health, with no more than 1.2 trained mental health workers per 100,000 population. Primary health workers are insufficiently trained about mental health and psychotropic medications availability is low. Objectives: This project aimed to reduce the treatment gap for depression, psychosis and epilepsy, by training community health workers (CHWs) and general practitioners (GPs), and raising awareness among the population. It also aimed to evaluate knowledge, attitudes, and practices (KAP) among the population, CHWs, and GPs pre- and postintervention, and monitor patient flow between CHWs and GPs. Methods: This 2-year interventional study was conducted in Hlaing Thar Yar. Seventy-six CHWs were trained to raise awareness, identify people with mental disorders, and refer them to GPs. Fifty GPs were upskilled to diagnose and manage patients. Low-cost digital technology was used: smartphones with interactive screening questionnaires by CHWs, and electronic tablets with e-medical records by GPs. Results: At baseline, the average treatment gap was 79.7% (90.3% for depression). During the 2-year intervention, 1378 suspected cases were referred by CHWs to GPs and 1186 (86%) of them saw a GP. Among the 1088 patients (92%) diagnosed with one of the three diseases, the concordance between GPs' diagnosis and CHWs' screening was 75.6%. The general population's KAP score improved between baseline and end line (driven by attitudes and practices). For CHWs, knowledge improved posttraining while attitudes and practices improved postintervention. GPs' global KAP score improved posttraining and remained stable postintervention. Conclusions: This project suggests that a 2-year intervention including the training of frontline health workers and raising awareness among the population can have positive outcomes and lead to better diagnosis and management of people with mental disorders.
| Genetic Underpinnings of Mental and Substance Use Disorders: Current Understanding and Potential Scope | | |
Rizwana Quraishi, Piyali Mandal, Raman Deep, Preethy Kathiresan
Department of Psychiatry and National Drug Dependence Treatment Center, All India Institute of Medical Sciences, Delhi, India
E-mail: [email protected]
Abstract
The symposium will start with an introduction to the genetics of mental and substance use disorders. It shall briefly discuss the factors affecting the expression of genetic risk including gene and environment interactions. Various methods to identify potential gene(s) which may also have a role in vulnerability and pharmacological response will be presented. An overview of potential scope of genetics in mental and behavioral disorder will be discussed. Gene and gender differences in substance use disorder: Sex differences and gender are not solely determined by biology, nor are they entirely sociocultural for any mental health conditions including addiction. The interactions among biological, environmental, sociocultural, and developmental influences result in phenotypes that may be more masculine or more feminine. There is accumulating evidence of variations in genetic expression along with other factors in the observed gender differences. The second presentation will attempt to summarize the role genes play in the observed gender differences in substance users. The third presentation will discuss genetic vulnerability for mood (or affective) disorders in particular, especially in the context of its clinical and psychosocial ramifications for individuals and families. A synthesis of the latest research findings from studies on patients with mood disorders and their first-degree relatives shall be presented, followed by a discussion on potential for applications to routine clinical practice and psychosocial interventions offered by clinicians. Finally, the symposium shall discuss the genetics of substance use disorders, with particular focus on alcohol use disorders. The presentation will discuss about the available literature on the role of genetics in the course of substance use disorder, the role of pharmacogenetics in treatment of substance use disorder, its limitations, and future directions for researchers and clinicians.
| Challenges in multicentric research in social psychiatry | | |
Sandeep Grover, Ajit Avasthi
Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
E-mail: [email protected]
Abstract
Till recent times, there was dearth of multicentric studies in psychiatry from India. In the last few years, Indian Psychiatric Society and other similar professional organizations have started conducting multicentric studies with low level of funding. These multicentric studies have focused on various clinical and psychosocial aspects of different psychiatric disorders. However, conducting these multicentric studies has been challenging. The various challenges involve selection of research question which can be easily implemented across the different sites, selection of different study sites, getting ethical clearance from the ethics committees of different sites, adaptation and translation of instruments in local languages to ensure consistency of data collected, and coding and analyzing the data. At every stage, the principal investigator and the coordinating site play an important role, in ensuring the consistency and reliability of the collected data. However, the whole experience can also be very fulfilling once the research papers see the light of publications.
| sMMSE – Its Need and How to Administer | | |
Adwitiya Ray, Neha Puri, Hitesh Khurana
E-mail: [email protected]
Abstract
The Mini-Mental Status Examination (MMSE) is being used extensively in clinical and research settings for assessment of cognitive impairment. However, it has its own shortcomings for which alternatives are important. The goal of standardized MMSE was to impose strict guidelines for administration and scoring which has led to many advantages over MMSE. This workshop will use questionnaires, interactive examples, and small exercises to give a hands-on experience about the administration and scoring of sMMSE. This workshop will help attendees to have a better understanding of sMMSE.
| Innovative Online Teaching of Basic Psychotherapy Skills: A Hands-On Workshop | | |
Praveen Alexander, Johann Alex Ebenezer, Angeline Salome Lydvina George, Stephy Stephan, Snehal Jayant Joshi
Department of Distance Education, Christian Medical College, Vellore, Tamil Nadu, India
E-mail: [email protected]
Abstract
The COVID-19 pandemic has brought online and distance education to the forefront of education, including in the field of psychiatry. It has become essential to adopt online teaching methods alongside traditional residential face-to-face teaching. Student engagement online has often been considered challenging and has impacted learning outcomes. The presenting team consists of academic faculty of the Post Graduate Diploma in Mental Health run by the Department of Distance Education, Christian Medical College, Vellore. This blended learning course consisted of online modules and face-to-face teaching sessions that used to be in-person, which had to become exclusively online in view of the pandemic situation. Teaching methods had to be redesigned to facilitate student engagement and maximize learning outcomes. This hands-on workshop provides an opportunity to experience some of these innovative techniques in the context of teaching a basic psychotherapy skill (group psychoeducation) online.
| Oral Communication | | |
| Quality of Sleep and Stress in Patients with SARS-COV-2 Infection: A Cross-sectional Study in Northern India | | |
Prabhmeet Singh, Yoginder Malik, Bhupendra Singh, Rajiv Gupta
Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Introduction: The emergence of sleep disturbances in response to major stressful events including natural disasters (e.g., wildfires, earthquakes, floods, and pandemics) has been documented innumerable times in history. The circadian factors and homeostatic factors interact constantly for maintaining the sleep–wake cycle. COVID-19 pandemic has produced unparalleled changes in our lives: worry, stress, anxiety, and sleep disturbances. The maintenance of adequate sleep–wake cycle and circadian rhythm is essential for proper stress coping of patients with COVID-19 infection. The index study aims to study the sleep disturbances, stress, anxiety, and depression in patients with COVID-19 infection. Methodology: It was a cross-sectional study conducted in COVID-19 patients at dedicated wards of Post Graduate Institute of Medical Sciences, Rohtak. A purposive sample of 50 patients with COVID-19 infection was taken. A specially designed pro forma was used to gather sociodemographic and clinical details of the patients. Insomnia, stress, anxiety, and depression were assessed by the Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Depression, Anxiety, and Stress Scale, respectively. The data thus collected were analyzed using descriptive statistics for discrete and continuous variables. Chi-square test was used for comparing the categorical variables and t-test was used for comparing the continuous variables. Results: The results will be discussed in the light of insomnia, stress, anxiety, and depression and also among various sociodemographic and clinical variables. Conclusion: Proper sleep–wake cycle and circadian rhythm are important in a person's life, especially when affected by a debilitating disease. Sleep hygiene practices thus become essential to promote good stress coping in present times of social isolation, thereby reducing the incidence of anxiety and depressive disorders.
| Brief Intervention for Suicide Prevention: Exploratory Study | | |
Hemendra Singh, Mohan S Raju, C Swati
Department of Psychiatry, MS Ramaiah Medical College, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: About 800,000 persons die due to suicide worldwide annually. Studies have shown that approximately 50% of people who died by suicide sought health-care services before they died. Risk of suicide is high, especially during the first 3 months after discharge, with the highest number of suicides within the 1st week. Hence, intervention before discharge becomes important. Objective: To assess the efficacy of brief intervention module for suicide prevention. Materials and Methods: Interventional study was conducted in Ramaiah Hospital from February 2020 to January 2021. Consecutive patients aged 18–60 years who presented to Accident and Emergency with current suicide attempt were included. Data pertaining to sociodemographic details, methods, and reasons of self-harm were recorded. Cognitions related to suicide were measured using the Suicide Cognitions Scale (SCS) before and after intervention. A three-session brief intervention module for suicide was given to every patient and telephonic follow-up was done for 6 months post discharge. The primary outcome of reattempt and secondary outcome of suicide cognitions were measured. Results: Of the 40 patients recruited for the study, 30 completed 6-month follow-up. Most of them were female (n = 21, 70.0%), aged below 30 years (n = 17, 56.7%), married (n = 15, 50.0%), employed (n = 21, 70.0%), and had urban residence (n = 17, 85.0%). The most common method of self-harm was poison/corrosive consumption (n = 13, 43.3%) followed by overdosing on pills (n = 11, 36.7%) and reason for self-harm was family problems (n = 15, 50.0%). There were no reattempts during the 6-month follow-up. The mean of SCS reduced from before therapy (M = 70.05, standard deviation [SD] = 14.51) to after therapy (M = 26.6, SD = 7.32) which was statistically significant (P < 0.001). Conclusion: Brief intervention module comprising 3 sessions prior to discharge appears to be effective in prevention of reattempts of suicide and reduction in suicide cognitions.
| “It is Better to Stay Away from Tablets, Even If They are Vitamin Tablets”: Parental Perceptions of Nutritional Supplements for Cognitive Enhancement in India | | |
Jayashree Dasgupta, Georgia Lockwood Estrin, Zenia Yadav
Samvedna Senior Care, Gurgaon, Haryana, India
E-mail: [email protected]
Abstract
Background: Meta-analyses with studies taking place in low- and middle-income countries (LMICs) find childhood nutritional supplementation benefits of cognitive development. They have been incorporated into public health policy due to ease of scalability. However, little is known about how parents in LMIC settings view the use of nutritional supplements as a cognitive enhancement approach to help children attain their full cognitive developmental potential. Objectives: This study aims to explore parental perceptions on the use of nutritional supplements and vitamins to enhance children's cognitive potential in an LMIC context. Methods: In-depth interviews (n = 11) and focus group discussions (n = 2) were conducted with parents of primary school-going children in Delhi, India. Parents were recruited from high and low socioeconomic status (SES) to explore perceptions of parents with varying access to resources. Transcripts were analyzed using exploratory thematic analysis. Results: Analysis revealed that nutritious food and healthy eating were considered most beneficial for enhancing children's cognitive development. Parents viewed nutritional supplements and vitamin pills differently to healthy eating, with them being viewed similarly to nootropic drugs; concerns were raised about their effectiveness for cognitive enhancement. Interestingly, how nutritional supplements were endorsed was also an important theme, with greater trust in vitamin pills if prescribed by a doctor. Particular brands of nutritional supplements were endorsed highlighting the role that marketing and advertising play in influencing parental perceptions. Affordability was a limiting factor for parental acceptability toward nutritional supplements and vitamin pills, especially those from low SES. Conclusion: Parents viewed supplements with similar concern and skepticism as nootropic drugs for cognitive enhancement, emphasizing that a universal approach to nutritional supplementation may not be acceptable. We highlight the importance of how supplements are endorsed, which is important to keep in mind for building parental trust and improving the uptake of nutritional supplementation with children.
| Telementoring for Community Health Officers of Chhattisgarh: Bottom-Up Approach in Primary Care Psychiatry | | |
Monika Thakur, Akshita Kumari Verma, Praveen Pandey, K Pushpa, N Manjunatha, C Naveen Kumar, Suresh Bada Math, Sumi Jain
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Community health officers (CHOs) are mid-level health providers posted at health and wellness centers (formerly subcenters/primary health centers) and serve as the first point of contact with patients in the community. The CHOs receive short-term mental and neurological disorders training as part of comprehensive primary health-care package. NIMHANS has started online training of CHOs in Chhattisgarh to equip the CHOs in identification, screening, and referral of psychiatric illnesses. Objective: To showcase a novel bottom-up approach to primary care psychiatry by engaging CHOs in online training. Methods: In June–July 2021, 430 CHOs enrolled in the first phase of training. The training consisted of nine online e-learning and skill development (eLSD) modules of 2 h each. CHOs were trained in use of Mental Health Screening and Counselling for Field Level Workers of India (MERIT) Tool for screening commonly occurring mental health concerns including tobacco and alcohol use, depression, somatoform, anxiety, psychosis, and suicide. The eLSD sessions incorporated didactic, roleplay and case scenario-based teaching describing screening, identification, psychological first aid, and referral for the aforementioned diagnoses. Results: Three hundred and thirty CHOs from ten districts of Chhattisgarh attended three or more sessions. Over a period of 2 months, 60 CHOs identified and discussed 102 psychiatric cases over video conferencing including 56 (54.9%) with common mental disorders, 58 (56.8%) with severe mental disorders, and 44 (43.1%) cases with substance use disorders. Conclusion: Following the training, the CHOs were able to screen and identify psychiatric patients presenting to the health and wellness center. The bottom-up approach using online training of CHOs is a scalable method for task shifting in primary care psychiatry.
| Burnout among Health-Care Professionals in COVID-19 Duty | | |
Bhupendra Singh, Purushottam, Priti Singh, Rajiv Gupta
Institute of Mental Health, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: Burnout is common among health-care workers. Characteristics of the health-care environment, including time pressure, lack of control over work processes, role conflict, and poor relationships between groups and with leadership, combine with personal predisposing factors and the emotional intensity of clinical work to put clinicians at high risk. The current pandemic of COVID-19 due to high vulnerability for infection, massive patient load, and high expectations from the community, officials, and themselves multiplies the challenges of health-care professionals. Aim: To assess the Burnout among Health-Care Professionals. Materials and Methods: A cross-sectional multicentric online onetime assessment. The study was conducted through the Internet by using Google Forms without specific geographical area, although it was intended to focus on Indian professionals. A sum of 182 health professionals participated in the study. Individuals who are posted in COVID-19-dedicated hospital or COVID care center were included in the study. Professionals who tested positive for COVID-19 in the last 1 week, lost any family member or close friend in the last 2 weeks and had self-reported chronic illness were excluded. Results: All 182 health-care professionals were aged between 22 years to 49 years; the mean age of participants was 28.60 + 4.88. Total 70.32 female and 29.67 male and 54.4 of them were males. 35.16% of duty doctors, 32.41% of nursing staff, and 30.76% of other paramedical staff participated in the study. Burnout was significantly high in the second wave in comparison to the first wave.
| Alcohol Use among Patients in Opioid Substitution Therapy in Nepal | | |
Sagun Pant, Lars Lien, Suraj Bahadur Thapa, Saroj Prasad Ojha
Institute of Medicine, Kathmandu, Nepal
E-mail: [email protected]
Abstract
Background: Home-brewed alcohols have been traditionally used in Nepal, and now with “traditional sanctions and caste-bound restriction” in alcohol use quietly vanishing, alcohol use has burgeoned. Opioid use is another important public health problem in Nepal. Out of the 130,000 drug users in Nepal, almost half of them reported opioid use. Despite the predominance of abstinence-based treatment measures, opioid substitution therapy (OST) for a decade now has been used as an evidence-based treatment approach for opioid use disorder (OUD) in Nepal. However, there are concerns of concurrent alcohol and substance use while using OST, which affects the treatment outcome. Objectives: The objective of the paper is to explore the estimate of alcohol use, hazardous use, and alcohol use disorder among OST clients receiving treatment from OST sites in Kathmandu, Nepal. Methods: In our cross-sectional study, a total of 231 clients in OST sites were evaluated. Evaluation was done using semi-structured questionnaire, Mini-International Neuropsychiatric Interview, and Alcohol Use Disorders Identification Test (AUDIT). Results: Among the OST clients, 90% had ever used alcohol. The mean age of first use of alcohol was 17.5 years, which was about 3 years earlier to mean age of first opioid use (20.5 years). Among all clients, 18.61% (n = 43) were diagnosed with alcohol use disorder and 17.31% had an AUDIT score of greater than 7, meaning at least hazardous alcohol use. Conclusions: The observation in the paper highlights an urgent need for concurrent intervention for problematic alcohol use among OUD in Nepal. Service providers will have to address alcohol use to stabilize people with OUD in aspects of social, mental, physical, and cultural life.
| A Cross-Sectional Study of Academic Resilience and its Association with the Previous Schooling in the MBBS Students | | |
Nimmy Chandran, Sajal Sathiadevan, K S Deepak
Department of Psychiatry, Government Medical College, Palakkad, Kerala, India
E-mail: [email protected]
Abstract
Background and Objective: Academic resilience is the ability to bounce back in academic adversities. It tells the possibility of academic success despite adversities in academic life. This study aimed to find out academic resilience and its association with previous schooling in medical students. Methods: This was a cross-sectional study, conducted at the Government Medical College, Palakkad. Study participants were MBBS students in Government Medical College, Palakkad, who were consenting to participate in the study (n = 162). The study assessed the academic resilience score of the MBBS students using the Academic Resilience Scale-30. A semi-structured pro forma was used to know the sociodemographic profile and the previous schooling details of the participants. Results: A total of 162 students completed the study. Among those, 123 (75.9%) were female students and 39 (24.1%) were male students. A total of 111 (68.5%) students studied in a government school and 51 (31.5%) students studied in a private school before joining the medical college. One hundred and ten students (67.9%) studied in English medium school and 51 (31.5%) students studied in Malayalam medium school. Among the total students, 93 (57.7%) students studied in the Kerala state syllabus school, 57 (35.4%) students studied in the CBSE school, and 8 (5%) students studied in the ICSE school. Forty-five (28%) students underwent residential schooling and the rest underwent nonresidential schooling before joining the medical college. The mean academic resilience score was 120.25, which is moderate. We could not find any statistically significant difference in the academic resilience score of students who studied at a government school or private school, state syllabus or CBSE syllabus, English medium or Malayalam medium, and residential or nonresidential schooling. Conclusion: The academic resilience of MBBS students was not associated with the type of previous schooling, syllabus, or the medium of communication.
| Metacognition in Relation to Maladaptive Mobile Phone Use among Schoolchildren during COVID-19 Pandemic | | |
Andree Jaiswal, Preeti Gupta, Sanjay Kumar Munda
Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Background: Maladaptive mobile phone use is not uncommon among schoolchildren and adolescents. Recent research has suggested that metacognitions may play a role across the spectrum of addictive behaviors, including problematic use of technological devices. Aim/Objective: The present study tended to explore the metacognition among schoolchildren with maladaptive mobile phone use during the COVID-19 pandemic. Methods: The sample was collected online through Google Forms from 83 students of classes 7th-9th from two secondary co-educational schools from the schools of Kanke, Ranchi, India. The WhatsApp group for different sections of classes of 7th, 8th, and 9th was used to send an online link to the Google Forms consisting of forms for parental assent, sociodemographic and academic datasheet, Questionnaire about Experiences related to Cellphone, and Metacognitions Questionnaire-A. Results: The results of the present study showed that 68% of school-going children from classes 7th-9th had maladaptive mobile phone use, out of which 20% had problematic use and 47.5% had occasional problems. All the domains of metacognition were elevated in the problematic use group. The domains of positive beliefs about worry, cognitive self-consciousness, negative beliefs about uncontrollability of danger, and need to control thoughts were elevated in children with the maladaptive mobile phone use. The domains of cognitive self-consciousness, negative beliefs about uncontrollability of danger, and need to control thoughts were elevated in children with maladaptive phone use having occasional problems. Conclusion: Although more research is needed to identify the underlying mechanisms, findings suggest a need to sensitize students about high-frequency mobile phone use, curb the problematic use, and modify the nonproductive metacognitive beliefs.
| Management Difficulties of Avoidant/Restrictive Food Intake Disorder in Adults: A Case Report with Review | | |
Sayan Saha, Nileswar Das, Prateek Yadav, Pratap Sharan, Gagan Hans
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]
Abstract
Background: The new diagnosis of avoidant/restrictive food intake disorder (ARFID) was introduced in the Diagnostic and Statistical Manual of Mental Disorders-5 to acknowledge that avoidant and restrictive eating symptoms can occur in all ages without any disturbances in perception toward body weight and shape. Individuals with ARFID avoid food intake due to their sensory properties, disinterest in food, or a fear of negative consequences from eating/food handling. Available literature suggests a possible biopsychosocial nature of the illness origin. There is also an increased risk of future development of ARFID in individuals with a history of any form of food intolerance. Herein, we present a case of ARFID in an adult male with various predisposing and perpetuating factors requiring a multimodal therapeutic approach. Case Description: A 47-year-old married male with obsessive–compulsive personality disorder and irritable bowel syndrome (IBS) presented with restricted feeding patterns for the last 16 years, leading to a dangerously low body mass index (13.15 kg/m2). He also had a history of low mood with suicidal ideation and multiple complications (e.g., nutritional deficiencies and dyselectrolytemia) because of restricted feeding for the last few months warranting an immediate hospitalization. The patient was diagnosed with ARFID with comorbid major depressive disorder (MDD). He had a family history of MDD with anorexia nervosa in his daughter with dysfunctional interpersonal relationships (IPRs) with multiple family members. After medical stabilization, a multimodal therapeutic approach was adopted. Nutritional rehabilitation was started in liaison with a gastroenterologist/nutritionist. Psychosocial interventions to address IPR issues, mood symptoms, and problematic feeding patterns by a team of psychiatrists, psychologists, and occupational therapists were done. Conclusion: This case highlights the interplay of biological (e.g., genetics/family history), psychological (e.g., personality organization), and social (e.g., strained IPR with family) factors in the development and maintenance of ARFID in adults. Comorbid MDD and IBS complicated the scenario, requiring a multimodal treatment approach.
| Assessment of Perceived Stress during Corona (COVID-19) Pandemic among Health-Care Workers | | |
Akhilesh Jain, Kuldeep Singh Yadav, Naman Jain, Neelam Yadav, Garima Jain
ESIC Model Hospital, Jaipur, Rajasthan, India
E-mail: [email protected]
Abstract
Introduction: The pandemic of COVID-19 has caused both physical and psychological suffering not only to general population but also health-care workers (HCWs). Assessment of mental stress in HCWs is important as they have played a crucial role during this pandemic. Aims and Objective: To assess the level of stress in HCWs during COVID-19 pandemic. Materials and Methods: Hindi version of the Perceived Stress Scale-10 was used to assess the stress in this online cross-sectional study. Results: The level of perceived stress was significantly higher in HCWs working in government hospitals, quarantine services, and nursing and paramedical staff. Although not statistically significant, stress was more among female HCWs, those from nuclear family, younger age group, and those who had been taking treatment for some psychiatric illnesses. Conclusion: There is a need to assess the ongoing stress among HCWs and address the contributing factors, thus enabling them to perform their duties more effectively and optimally.
| Psychedelics and Social Psychiatry: How Individual Benefits Include Social Application | | |
John Halpern
Harvard Medical School's McLean Hospital, Belmont, Massachusetts, United States
E-mail: [email protected]
Abstract
Out of the several thousand years humans have experienced hallucinogenic substances, the last 50 years are perhaps the most misunderstood of all. How did psychedelics come from the most venerated substances of the ancient/shamanic world to be some of the most reviled/feared of the “modern” world? More pressingly, why are psychedelics gaining greater legitimate evaluation once more? Quite simply: individual and societal need. Religious (NAC/Peyote, Bwiti/Iboga, Santo Daime/UDV/Other/Ayahuasca, Shamanic/Psilocybe), “spiritual seeking,” reverential/ecstatic/eventful, and medical (depression, cluster headache, relationship issues, end of life, OCD, and substance use disorders) – these substances achieve results in communal application and sometimes with quite specific, reproducible results already (MDMA, LSD, Psilocybin, Cannabis). While anecdotal, it is also historical that those reporting the best responses to these substances often donate charitable or other new/renewed endeavors of importance beyond their individual need. Indeed, psychedelics in the 1960s were “blamed” for contributing to the anti-Vietnam War Movement, the Civil Rights Movement, the Environmental Movement, Organic Foods/Vegetarianism, and the Equal Rights/Women's Rights Movement. This presentation will review lessons gained as well as suggest where psychedelics are important for social psychiatry to integrate.
Keywords: Happiness, psychedelics, reform, religion, treatment refractory
| Virtual Reality and its Current and Future Potential Role in Mental Health Care | | |
Aida Mihajlovic, Christopher Reggi, Seher Siddiqui
University of Illinois, Chicago, Illinois, USA
E-mail: [email protected]
Abstract
Virtual reality (VR) uses technology to temporarily transport patients to simulated 3D alternate environments, enabling patients to experience new realities. Studies show that VR is just as effective as in vivo exposure therapy in treating various anxiety disorders. VR alleviates burdens associated with in vivo exposure therapy, increasing patients' sense of safety and therapists' control, lowering costs, standardizing training in exposure therapy, and reducing the time burden for therapists. VR offers a “best of both worlds” where full manipulative and experimental control meets strong replicative ability and reproducibility. The limitations and setbacks of VR treatment include but are not limited to slow development and implementation, high costs for software and accessories, oversaturation of the market with applications leading to lack of standardization, and general negative emotions that VR therapy elicits. Nevertheless, VR offers a potential answer to a wide array of clinical questions. Development and progression depend on continued research and funding that should be viewed as a valuable addition to current mental health initiatives.
| Assessment of the Course of Sexual Dysfunction in Different Domains of Hypertensive Males and Correlation with Patient Characteristics – A Longitudinal Study | | |
Ankit Halder, Navna Panchami Ravindran, Devavrat Harshe
DY Patil Medical College Hospital and Research Institute, Pimpri-Chinchwad, Maharashtra, India
E-mail: [email protected]
Abstract
Background: Patients with hypertension have a higher risk of developing sexual dysfunction. It can directly or indirectly affect various aspects of sexual functioning. Side effects of drugs may also aggravate these. Objectives: (1) To study the prevalence of sexual dysfunction in different domains in hypertensive males with sexual dysfunction. (2) To study the course of sexual dysfunction in those taking treatment for the same compared to those who are not. (3) To correlate the findings with age group, type of antihypertensive drug and duration of antihypertensive therapy. Methods: All male patients presenting to the general medicine OPD who (1) were diagnosed with primary hypertension, (2) were taking antihypertensives for a minimum period of 2 years, and (3) did not have comorbid diabetes mellitus or endocrinological disorder and neuropsychiatric disorders during the past 6 months were included. Patients were assessed using the International Index of Erectile Functioning for dysfunction in different domains. Treatment options in the form of drugs and psychotherapy were provided for those afflicted, and were followed up after 6 months. Results: Our sample consisted of 56 males. The prevalence of sexual dysfunction was 34% for males. The highest and lowest prevalence rates for sexual dysfunction were noted in patients taking beta-blockers (47%) and thiazide plus telmisartan combination (25%), respectively. Most domains were affected in those taking antihypertensives for more than 20 years (80%). Post intervention, domains that improved most were erectile dysfunction (83%). Domains that were least affected were orgasmic function domain (88%). Conclusions: Sexual dysfunction is prevalent in a considerable proportion of hypertensive males. The dysfunction is not only limited to erectile dysfunction or desire as it affects all the domains. Different antihypertensive agents cause sexual dysfunction in different spectrums. Post intervention, improvement is also domain specific.
| Sleep Architecture and Smartphone Usage among Students Using Telemetric Approach | | |
Ankit Halder, Navna Panchami Ravindran, Devavrat Harshe
DY Patil Medical College Hospital and Research Institute, Pimpri-Chinchwad, Maharashtra, India
E-mail: [email protected]
Abstract
Background: Smartphone usage has increased considerably over the past two decades. Smartphone screens emit light rich in blue wavelength that has significant effects on neurophysiological functions. Objectives: The aim of this pilot study was to evaluate if the blue light emitted by smartphones affects the sleep quality and chronotypes in medical students. We decided to take an objective, telemetric approach to avoid any subjective rater's bias in reporting self-smartphone usage. Methods: Fifty students from third MBBS were examined for sleep quality with Pittsburgh Sleep Quality Inventory (PSQI). Their perceived smartphone usage was assessed with Smartphone Addiction Scale-Short Version. Telemetric apps were used to measure their cumulative smartphone usage and lock–unlock cycles in a predetermined 7-day period. Brightness of the smartphone screen was assessed with Lux-Meter-100k. Results: We found 50% of the students suffering sleep problems as per PSQI cutoff score. The mean cumulative smartphone usage was 2418 ± 1052 min and the mean lock–unlock cycle count was 483 ± 216. Linear regression (F [2,47] = 8.625, P = 0.001) showed that bedtime (ß = −0.312, t = −2.497, P = 0.016) and smartphone usage post sunset (ß = 0.392, t = 3.134, P = 0.003) to be the only significant predictors of PSQI score. Significant correlation was found between daytime dysfunction subscale of the PSQI and cumulative smartphone usage (r = 0.435, P < 0.05) and total lock–unlock cycle count (r = 0.394, P < 0.05). Conclusions: Smartphone use affects sleep measures qualitatively and quantitatively. Continuous smartphone uses as well as intermittent exposure affect certain measures of sleep quality. Telemetric measurement of smartphone usage is an effective, simple, and objective method for smartphone research.
| Effect of COVID-19 on Depression, Anxiety, and Sleep in Indian Population: Infodemiology Study | | |
Ragul Ganesh, Shreeya Gyawali, Koushik Sinha Deb
Department of Psychiatry, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: Coronavirus disease (COVID-19) has impacted health-care services worldwide. Research around the world showed various mental health issues including mood and sleep disturbances. Objective: This study aimed to estimate the effect of COVID-19 on mental health in India using Google search trends. Methods: We measure national-level interest in mental illness during the period between December 2019 and May 2021 using the search terms in Google Trends. We compared the population-level interest in mental illness-related search terms before and after the onset of COVID-19 in India. Results: We compared the population-level interest in keywords related to mental illness before and after COVID-19 in India. The number of search queries related to mental illness has increased after COVID-19. Mann–Whitney test showed a statistically significant increase in search queries for depression (U = 1043.500, P < 0.01), anxiety (U = 1137.500, P < 0.01), insomnia (U = 1204.000, P < 0.01), and suicide (U = 1188.000, P < 0.01) after the onset of a pandemic. Conclusions: These results highlight the impact the COVID-19 pandemic has on mental health and the need for making effective interventions accessible. Future studies will be needed to determine whether the increase in mental illness issues will persist in the population once the pandemic is over.
| Attention Deficit Hyperactivity Disorder Following Hypothalamic Hamartoma Surgery | | |
Archish Khivsara
AIIMS, Jodhpur, Rajasthan, India
E-mail: [email protected]
Abstract
Background: Psychiatric symptoms are a common comorbid feature of hypothalamic hamartoma with epilepsy. They are most disabling and are a significant challenge for the patients and their families. Most commonly, psychiatric symptoms present with externalizing behaviors such as aggression and rage attacks. Objectives: To outline an atypical presentation of hypothalamic hamartoma in the form of attention deficit hyperactivity disorder symptoms. Methods: A 6-year-old child born out of nonconsanguineous marriage, with history of hyperemesis gravidarum and depressive disorder in mother in antenatal period, delivered by normal vaginal delivery at term (did not cry at birth and was hospitalized for 3 days) with birth weight of 2.25 kg, currently presented to neurology with developmental delay in all domains and history of gelastic seizures at 3 years of age. The patient was diagnosed with pituitary hamartoma (through magnetic resonance imaging [MRI]) and precocious puberty that time and was operated for the same after which he started having behavioral issues such as irritability, aggressive behavior, hyperactivity, interrupting others, and lack of appropriate social behavior with peers or parents along with defiance toward parents. The child was referred to psychiatry for the above. On mental status examination, the patient was not interested in interacting with the interviewer and was noticed to shout loudly when instructed to stop playing with mobile phone. MRI brain (2 months back) showed postoperative changes with cystic lesion in the suprasellar region. IQ assessment showed borderline intelligence. Results: The patient was started on risperidone optimized up to 1.5 mg, after which the patient showed some improvements. However, antiepileptics are being rationalized to prevent behavioral issues secondary to epilepsy. Conclusion: Patients with hypothalamic hamartoma present with a broad spectrum of psychiatric symptoms. Although psychiatric outcomes improve after surgery in patients with hypothalamic hamartoma with epilepsy, we came across a child with worsening of psychiatric symptoms after he was operated for the above lesion.
| Depressive Symptoms and Stressors in Perinatal Women during Two Peaks of COVID Pandemic in India – Findings from Brief Intervention for Depression in Pregnancy Study | | |
Prerna Kukreti, Manju Puri, Ramdas Ransing, R Pracheth, Mahesh, V Omsai Ramesh, Sumit Rana
LHMC, New Delhi, India
E-mail: [email protected]
Abstract
Background: Pregnancy and postpartum phase is a high-risk period for developing depressive symptoms in general. Outbreak of COVID-19 posed additional challenges. Research is needed to determine the prevalence and determinant of depressive symptoms during pandemic. Objectives: To assess the prevalence of depressive symptoms and stressors in perinatal women availing services from antenatal care (ANC) and postnatal care (PNC) outpatient department (OPD) during two peaks of COVID pandemic. Methodology: This study is part of an ongoing cohort trial, Brief Intervention for Depression in Pregnancy. The Patient Health Questionnaire-9 (PHQ-9) Hindi version and a semi-structured questionnaire assessing sources of stress were applied on women availing ANC/PNC OPD services of a tertiary care hospital in Delhi. Data were collected cross sectionally during two different timeframes in the month of March 2020 and April 2021, representative of two different peaks of COVID in capital. Regression analysis was done to ascertain differences across the two time frames. Results: A sample of 100 women were recruited in each phase of pandemic. Prevalence of depressive symptoms using PHQ-9 score >5 during the first and second peaks was 17.3% and 11.9%, respectively (P = 0.002). The main sources of stressors reported during first pandemic were concern about getting infected (72%), transportation difficulty (96%), not aware about running of health-care services (86%), well-being of infant (89%), isolation (63%), loss of social support for child care (83%), not being able to conduct rituals (72%), and inability to get self/infant vaccinated timely (62%). Stressors reported during the second peak were concern about getting infected (85%), inability to get bed for hospitalization (87%), fear of death for self or infant (74%), and financial difficulties (22%). Conclusions: Such high rates of perinatal depressive symptoms warrant need of screening for depressive symptoms, monitoring, and target other determinants of emotional well-being to plan appropriate public health policies.
| Psychiatric Comorbidities and Level of Self-Esteem in Individuals with Morbid Obesity | | |
Kritika Agarwal, V Om Sai Ramesh, Nitin Raut, Dinesh K Kataria
LHMC, New Delhi, India
E-mail: [email protected]
Abstract
Background: Morbid obesity has been described as body mass index (BMI) more than 35 kg/m2 with or without comorbidities. Psychiatric disorders in morbidly obese individuals have been reported to be high in Western literature, but currently, Indian data are lacking. Aims and Objectives: To estimate the prevalence of various psychiatric disorders in morbidly obese individuals and to assess the effect of BMI on their level of self-esteem. Methods: It was a cross-sectional hospital-based study. Participants (n = 50) were recruited from outpatient departments with a prior diagnosis of morbid obesity. Ethical clearance was obtained from the institute ethics committee. After informed content, all participants were assessed using the Mini-International Neuropsychiatric Interview (MINI) (for psychiatric morbidity) and Rosenberg Self-Esteem Scale. BMI and other medical information were recorded in a semi-structured pro forma. Data analysis was done using licensed SPSS v.25. Results: Data collection was completed between January and December 2020. Participants were predominantly female (n = 34, 68%) with a mean age of 43.4 (standard deviation [SD] = 10.1) years. The majority were married (n = 39, 78%), educated below high school (n = 30, 60%), unemployed (n = 27, 54%), and living in an urban area (n = 29, 58%). The mean BMI was 40.8 kg/m2 (SD = 4.2). Almost all participants (97%) had either one medical comorbidity, for example, diabetes (82%), hypertension (66%), nonalcoholic fatty liver disease (82%), and chronic pain (46%). The prevalence of psychiatric disorders was very high such as major depressive episodes (52%), suicidality (38%), generalized anxiety disorder (24%), and bipolar disorder (22%) as compared to the general population as per MINI. However, there was no significant association between BMI and the level of self-esteem (χ2 = 8.903, P = 0.342) in the participants of this study. Conclusions: Prevalence of depression, anxiety, bipolar disorder, and suicidality was significantly higher in morbidly obese individuals than what is expected in general Indian adults. Severity of obesity was associated with the level of self-esteem. Large-sample, multisite studies will be able to give better insight in future.
| COVID-19 Pandemic-Related Depression, Anxiety, and Stress, Sleep Quality, and Coping Strategies among Nursing Officers | | |
Shabnam Sayeed, Dilip Chandrakant Deshpande, Megha Sharma
Amar Jyoti Rehabilitation and Research Centre (Study Centre), Indira Gandhi National Open University (IGNOU), New Delhi, India
E-mail: [email protected]
Abstract
Background: In all epidemics, health-care staff are at the center of risks and damages caused by pathogens, specifically, nursing officers with unprecedented work pressure in the face of COVID-19 pandemic, resulting in several psychological disorder such as stress, anxiety, and sleep disturbance. The aim of this study is to investigate COVID-19 pandemic-related depression, anxiety, stress, coping, and sleep quality among nursing officers globally. Objectives: (1) To review and synthesize findings related to depression, anxiety, and stress level among nursing officers during COVID-19 pandemic. (2) To review sleep quality and associated sleep disturbance among nursing officers. (3) To review coping strategies adopted by nursing officers during COVID-19 pandemic. Methods: A systematic review was conducted using PRISMA guidelines and PubMed and Google Scholar databases were searched since December 2019 until July 2021. Results: The present study has reviewed a large number of studies and highlighted the significance for health policymakers to provide solutions and intervention to reduce workplace stress/pressure among nurses and engage in adaptive coping strategies.
| Study of Pattern of Neuropsychiatric Manifestations among Post-COVID Patients | | |
C Swati, Hemendra Singh
MS Ramaiah Medical College, Bengaluru, Karnataka, India
E-mail:[email protected]
Abstract
Background: COVID-19 pandemic has plagued the world for the past 2 years. Inflammatory response to SARS-CoV-2 virus, social isolation due to quarantine and lockdown, loss of loved ones to COVID-19, financial constraints, and fear associated with morbidity and mortality of COVID-19 infection are risk factors for developing neuropsychiatric symptoms in patients who have recovered from COVID-19 infection. Objective: To assess the sociodemographic profile neuropsychiatric manifestations in post-COVID-19 patients. Materials and Methods: A cross-sectional study was conducted in Ramaiah Hospital from June 2020 to June 2021. All patients who had tested negative after infection by COVID-19 and were referred by the treating physician from post-COVID clinic were recruited. Data pertaining to sociodemographic details, family history of COVID infection, and death due to same were recorded. Psychiatric diagnosis was made using the International Classification of Diseases-10. Results: Forty patients were recruited for the study. Most of them were male (n = 23, 57.5%), aged between 30–45 years (n = 14, 35.0%), married (n = 31, 77.5%), employed (n = 25, 62.5%), and had urban residence (n = 39, 97.5%). Most of the participants had family history of COVID-19 (n = 23, 57.5%), did not have death in family due to COVID-19 (n = 33, 82.5%), and did not suffer from preexisting psychiatric illness (n = 33, 82.5%). The most common psychiatric diagnosis was panic disorder (n = 13, 32.5%) followed by depression (n = 12, 30.0%). Conclusion: Mental health professionals should prepare to manage the mental health pandemic that is co-occurring with COVID-19 pandemic and is likely to continue beyond the COVID-19 infection pandemic.
| Prevalence of Internet Gaming Disorder during COVID-19 Pandemic among Young Adults | | |
Kalpana Panghal, Renju Sussan Baby, Shree Mishra
AIIMS, Bhubneshwar, Odisha, India
E-mail: [email protected]
Abstract
Introduction: Internet gaming disorder (IGD) is “the recurrent and repetitious use of online or offline based games, often with coplayers, that leads to significant damage in an individual's personal, family, social, educational, professional, or other vital areas of functioning.” Currently, there are limited data available regarding the prevalence of IGD. Furthermore, gaming behavior has increased during the pandemic period. Hence, this study aims to assess the prevalence of IGD and the impact of COVID-19 on gaming behavior during the COVID-19 pandemic among young adults. Methods: The present study follows an Internet-based, descriptive cross-sectional survey design; 721 participants aged 18–24 years were recruited for the study from the colleges of Bhubaneswar, Odisha. Data were collected via online Google Forms in the month of November 2020–January 2021 using IGD-20 test by the self-report method. Results: The prevalence of IGD and high-risk engagement gaming during the COVID-19 pandemic among young adults was found 2.9% and 18.4%, respectively. There was a significant difference found between IGD and non-IGD groups in terms of gender (P = 0.036), stress experienced due to COVID-19 (P = 0.001), gaming genre (P = 0.010), mode of game (P = 0.017), money paid for Internet gaming before COVID-19 pandemic (P = 0.003), and time spent on gaming after the onset of COVID-19 pandemic (P < 0.001). Conclusion: Gender, gaming genre, mode of game, money paid for Internet gaming before COVID-19, spending more time in gaming during the pandemic period, and high level of stress experienced due to the COVID-19 were found to be significantly associated with IGD. Hence, adopting healthy lifestyle by balancing between online and outdoor gaming, spending more time with family and friends may reduce the stress among young adults. Early identification and providing timely cognitive-behavioral intervention for the at-risk and disordered gamers are crucial remedial measures toward their early recovery.
| Illness Attitude and Prevalence of Health Anxiety among Women Diagnosed with Multiple Fibroadenomas | | |
Sushmita Kerketta
Central Institute of Psychiatry, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Background: Fibroadenomas are commonly found among women worldwide, but it is often overshadowed by other cancerous conditions pertaining to the breast. There are no medical treatments except surgical excision and the long and painful diagnostic process, rigorous screening, the “wait and watch” period to finally excise it, and its unclear epidemiology including its poorly understood transition to breast cancer can be very anxiety provoking. The associated worries related to body image, sense of beauty, self-esteem, and widespread stigma add more to it. Fears, beliefs, and attitudes associated with hypochondriasis and abnormal illness behavior among women living with multiple fibroadenomas remain unaddressed. Previous studies conducted on fibroadenoma, in general, also are suggestive of causing intense psychological distress and reduced quality of life among women with such condition. Objective: The study tries to explore the psychopathology associated, including the illness attitude and prevalence of hypochondriasis among young women diagnosed with multiple fibroadenomas across India. Methods: A mixed study was conducted among thirty women with multiple fibroadenoma. The administered questionnaire included the Illness Attitudes Scale (Kellner, 1986), along with open-ended qualitative questions. The respondents were identified randomly from a Facebook page and contacted for participation in the study. The inclusion criteria of the respondents were women of any age diagnosed with multiple fibroadenoma. The study excluded women with malignant and inflammatory mass. Results and Conclusion: Eighty percent of the respondents belonged to urban population, with education level of graduation and above. However, a considerable level of health anxiety was identified. In a pathological condition like multiple fibroadenoma, with prevalence of uncertainty in prognosis, the result of the study is indicative toward hypochondriasis. Suggestive of further investigations and interventions to remove stigma, reduce health anxiety, and better alternatives for management.
| Reasons of Initiation and Maintenance of Substance Abuse Behavior among Substance Abusers: A Phenomenological Study from Punjab (India) | | |
Sushil Kumar Maheshwari, Lovepreet Sidhu, Mamta Bahetra
Baba Farid University of Health Sciences, Faridkot, Punjab, India
E-mail: [email protected]
Abstract
Background: Psychoactive substance abuse is a relapsing chronic problem. The National Mental Health Survey (2015–2016) estimated that 4.7% of Indians have alcohol use disorder. Substance abuse negatively impacts on individual, families, societies, and nation. Persons with alcohol and opioid dependence have multiple reasons to initiate and maintain their substance abuse behavior. What we know about the reasons of substance abuse is restricted to data from quantitative studies which do not explain the complexities and competing challenges that exist. Different approaches are thereby required to extend understanding of the reasons of initiate and maintain substance abuse problems. Objective: The purpose of this study was to explore the lived experience of substance abusers with regard to reasons of alcohol and opiate dependence. Research Question: What are the reasons of substance abusers for their initiation and maintenance of substance abuse? Methods: Descriptive phenomenological approach by Husserl (1970) was used in this study. Eight participants were recruited for the study using the purposive sampling and data saturation technique. Semi-structured interview and focus group discussion with guided questionnaire were conducted. Interview guidelines were prepared based on research objectives, and they further translated into number of questions to explore the reasons of the substance abusers. The Colaizzi method was used for data analysis. Results: Four main themes emerged from the data for substance initiation: (1) peer group pressure; (2) family factors (freedom, lack of monitoring, and disobedience); (3) depression (stress); and (4) availability (money and substance). Three main themes emerged from the data for continue abuse of substance: (1) lack of self-control (physical and psychological); (2) lack of family monitoring; and (3) struggles of life. Conclusion: Understanding of reasons of substance abuse by policymakers is pivotal for developing successful culture-based preventive and rehabilitative strategies.
| Out-of-Pocket Expenditure among Poor Patients with Mental Illness Availing Outpatient Psychiatry Treatment | | |
Neha Kulkarni, T Sivakumar, K Muralidharan, B Binukumar
National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background and Aims: Eighty-five percent of health care in India occurs in private sector. Medications, investigations, and consultation charges form the bulk of out-of-pocket expenditure (OOPE). As per Mental Healthcare Act 2017, Section 18 (7), individuals living below poverty line (BPL) are entitled to free mental health services. NIMHANS, a tertiary institute, offers highly subsidized treatment for BPL patients. Aim: To study OOPE among BPL patients availing subsidized outpatient treatment over the last 1 year. Methods: Fifty patients aged 18–60 years, BPL, with diagnosis of F20-48 as per International Classification of Diseases-10, staying at least 30 km away, and availing subsidized treatment for at least 1 year from NIMHANS Outpatient Department services were recruited by convenient sampling. OOPE included direct and indirect costs. Direct costs included cost toward transportation, food, accommodation, paperwork, purchase of medications, investigations, and any other purposes related to the treatment. Indirect cost included wages lost on the day of hospital visit, loans, or monetary losses secondary to illness. Results: A median of Rs.3880/- OOPE was incurred by BPL patients per year for follow-up at NIMHANS, out of which direct and indirect cost amounted to a median of Rs. 2495/- and Rs. 950/-, respectively. Majority of direct costs were incurred from transportation (74.3%), and similarly, loss of pay was major indirect cost (26% of patients and 44% of caregivers). There was no statistical difference in average OOPE between severe and common mental illnesses. Conclusions: BPL patients and their caregiver spend 1 day each of their daily income to avail subsidized treatment for each follow-up. Mental health services need to be provided at primary care level so that patients can avail treatment closer to their residence and save OOPE to avail subsidized government health services.
| Coping Mechanisms in Patients with Alcohol Dependence Syndrome | | |
Vaishali Miglani, Sidharth Arya, Rajiv Gupta
Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: According to the World Health Organization, about 3.3 million deaths are caused by harmful use of alcohol each year. The processes by which a person manages any stressful demands are called “coping mechanisms,” and large data suggest that certain coping like avoidance coping may predispose a person to alcohol dependence. Adaptive coping strategies however seem to protect those who were psychologically distressed from excess alcohol consumption. Objective: To assess the coping mechanisms and their role in patients with alcohol dependence syndrome. Methods: Sixty male patients with alcohol dependence syndrome as per International Classification of Diseases-10 criteria were taken. Various sociodemographic and clinical variables were collected using a pro forma, especially designed for this study after obtaining their consent and fulfillment of inclusion and exclusion criteria. They were assessed for coping mechanisms by using proactive coping inventory, and the severity of alcohol dependence was studied by the Addiction Severity Index-Lite scale. Results: Among the study population of 60, there were significant positive correlation between the predisposition and severity of alcohol dependence and maladaptive coping patterns like avoidance and negative correlation between alcohol dependence and proactive coping in the study population. Conclusion: The presence of specific ways of maladaptive coping is related to excessive alcohol consumption. On the other hand, effective coping may act as a deterrent for the same and may play a role in the prevention policies for alcohol use and dependence.
| “A Mile in My Shoes:” Empathy and Compassion Fatigue in an Inadvertent COVID Warrior | | |
Nabagata Das, Shree Mishra, Susanta Kumar Padhy
AIIMS, Bhubaneswar, Odisha, India
E-mail: [email protected]
Abstract
Background: As the corona pandemic ravaged the world, the health-care workers adorned with the accolade of “COVID warriors” joined the war to preserve humanity. As a psychiatrist and a doctor responding to the call of duty and moral obligation, we joined the battle too. Objectives: To understand the viewpoint of a psychiatrist and a frontline COVID warrior. Methods and Results: (1) As psychiatrists, we are generally away from the nuances of emergency medicine. To manage a COVID ward on our own, we were always haunted by a sense of inadequacy and helpless. (2) We are trained to empathize and the power to empathize generally is a useful instrument in psychiatry. However, the same becomes a burden in the battleground of a COVID ward. As we realized, empathy is finite and sooner or later it runs out. Straining our voice across personal protective equipment trying to break bad news, failing to convey a word of sympathy to sick and ailing patients, and finally being reduced to being the doctor who recognizes patient by bed number and not name, all of this took its toll. Compassion fatigue set in. (3) And a week later, we were still reeling with the vivid experiences of the ward. During our therapy session, we barely had any words to console the patient sitting in front of us, talking about her insurmountable anxiety, oozing tears of desperation. Studies have shown a higher percentage of secondary trauma and compassion fatigue in mental health workers as well as critical care professionals. High caseload, history of previous trauma, and burnout contributed to, while mindfulness was found to be protective against compassion fatigue. Conclusions: The effects of being a psychiatrist who is also a COVID warrior leave its mark both on mental health and our professional work. Ill-equipped to manage medical emergencies, trained to empathize, and with limited resources to practice our skills, it will be worthwhile to explore the perspectives of more psychiatrists who are working as COVID warriors and thus help in shaping ways in which we handle our pandemic.
| Filicide in India: Medicolegal Profile Admitted to a Forensic Psychiatric Service | | |
Aishwariya Jha, Bhavika Vajawat, Prakyath Hegde, Guru S Gowda, Sundarnag Ganjekar, Sydney Moirangthem, Channaveerachari Naveen Kumar, Suresh Bada Math
National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: A significant proportion of both male and female patients accused of filicide have a preexisting mental illness. The presence of social isolation and life stressors have also been identified as important factors in filicide. Filicide is a sentinel event and can be a preventable cause of death, and there is a need to contextualize the findings to Indian settings. Objectives: To examine the clinical and sociodemographic characteristics of patients accused of filicide. Methods: A retrospective study design was employed. The study participants were accused of filicide and admitted to the forensic psychiatry services at the National Institute of Mental Health and Neurosciences between the years January 1, 2000, and March 30, 2021. The data collection was performed with the help of a semi-structured pro forma by anonymous data. Results: A total of 16 patients were reviewed, of which 9 were men. The mean age of the patients was observed to be 35.2 years. Fifty percent of the patients accused of filicide had a history of psychiatric illness (psychotic illness in 5 and mood disorders in 3) prior to the alleged crime. Financial issues, abuse, relationship difficulties with their partners, poor social support, and social isolation were noted in 50% of the patients. The most common mode of filicide was observed to be suffocation. Among the parents, male patients were observed to have used more violent means and employ means to hide evidence related to the crime. Conclusions: Mental illness and psychosocial adversities are common in filicide cases admitted to our services. Mental health and psychosocial factors can aid in identifying predictors and provide a means to assess filicide.
| Navigating through Troubled Waters: Exploring the Domains of Spirituality, Social Support, Depression, Death Anxiety, and COVID-19-Related Anxiety in Older Adults | | |
Lipika Malik, Shagufta Nasir, D Sindhura Yamini
Amity Institute of Behavioural and Allied Sciences, Amity University Mumbai (APMD), Mumbai, Maharashtra, India
E-mail: [email protected]
Abstract
The pandemic of coronavirus disease of 2019 (COVID-19) has led to multiple social, economic, political, and psychological changes worldwide. With health-care workers, scientists, policymakers, and related stakeholders finding a way to traverse through such times, the long-term psychological and metal health impacts of this pandemic are yet to be seen. With researchers worldwide investigating the mental health impacts of this pandemic, there are few populations more susceptible toward contracting the virus such as the older adults. The increased possibility of contracting the virus coupled with social distancing and isolation can put the older adults at increased risk of developing mental health problems. Research has demonstrated that older adults in general tend to suffer from depression, loneliness, anxiety, and other mental health issues. Hence, the present study aims to explore spirituality, social support, depression, death anxiety, and COVID-19-related anxiety. For this purpose, seventy older adults (aged 55 and above) will be taken as sample. Sociodemographic data sheet along with the Daily Spiritual Experience Scale, Multidimensional Scale of Perceived Social Support, Patient Health Questionnaire, Coronavirus Anxiety Scale, and Death Anxiety Scale will be used to assess spirituality, social support, depression, COVID-19-related anxiety, and death anxiety, respectively. Appropriate statistics would be used. The present study has implications in the field of clinical psychology, health psychology, positive psychology, and psychological medicine. The present study will be helpful in developing therapeutic interventions for management of coronavirus-related anxiety and depression in older adults.
| Prevalence of Workplace Violence: Its Psychological Impact and Association with Clinical Anger among Doctors Practicing in a Semi-urban District of Kerala | | |
Natasha Anto, Soumya P Thomas, Roy Abraham Kallivayalil
Department of Psychiatry, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India
E-mail: [email protected]
Abstract
Background: Workplace violence (WPV) against doctors has become a serious concern and can have adverse consequences both for the treating doctor and the service recipient by affecting the quality of health care provided. From a preventive perspective, whether the anger level of the victim triggers violence needs further research. Aim: To assess the prevalence of WPV and its psychological impact on doctors. To assess the association of clinical anger of doctors with the prevalence of WPV against them. Materials and Methods: A cross-sectional online survey will be conducted among a minimum of 100 doctors practicing in the district of Pathanamthitta, Kerala, using the modified version of the WPV in the Health Sector Questionnaire, developed by the WHO. Psychological impact will be assessed using the International Trauma Questionnaire. A semi-structured pro forma will be used to assess the sociodemographic details. The Clinical Anger Scale (Snell et al., 2013) will be used to assess the anger level of doctors. Results and Conclusion: To be presented.
| Psychosocial Factors in Adolescents with Functional Neurological Disorder: A Scoping Review | | |
Nikita Bhati, Rachna Bhargava, Rajesh Sagar, Rakesh K Chadda
Department of Psychiatry, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: Functional neurological disorder (FND) is a common and potentially disabling psychiatric condition. It has a history that may reach back into antiquity. Despite that, the researchers failed to establish the etiology of conversion disorder. Given the complex nature of the disorder, the body of research on risk factors related to FND among adolescents is very diverse and scanty. Objectives: This scoping review aimed to explore the psychological and social risk factors associated with FNDs in adolescents. Methods: The methodology of the scoping review was guided by Arksey and O'Malley (2005). A comprehensive search was conducted on PUBMED, EMBASE, Web of Science, Google Scholar, Psychosomatic Journal, and thesis database of literature published in the past 10 years. The retrieved articles were screened for inclusion and exclusion by two independent reviewers at both title and abstract levels. Results: A total of 2138 records were identified across all databases. Sixty-six full-text articles met the eligibility criteria as per the predefined inclusion criteria from screening and assessment of records. The findings were themed together to form 8 overarching categories: family factor, self-functioning, emotional processes, peer factor, school factor, coping, personality factor, and romantic relationship factor. Conclusions: The findings of the review suggest the multifactorial causes of FND in adolescents. A unified understanding is difficult to achieve due to the diverse and self-deceptive nature of the symptoms. High-quality research is needed to further determine the strength of these factors in adolescent patients who fall in fall in discrete clusters of functional neurological symptoms.
| Suicidal Behavior in New Patients Presenting to the Telepsychiatry Services in a Tertiary Care Center: An Exploratory Study | | |
Bhavika Rai, Rahul Chakravarty, Sandeep Grover, Subho Chakrabarti, Swapnajeet Sahoo, Aseem Mehra, Debasish Basu
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: In the wake of COVID-19 pandemic, the Government of India allowed the use of teleconsultations for providing routine clinical services. One of the major dilemmas in the mind of the clinicians is handling patients presenting with active suicidal behavior. Objectives: To evaluate the prevalence of suicidal behavior (death wish, suicidal ideations, suicidal plan, and suicidal attempt) in new patients presenting to the telepsychiatry outpatient services and handling of the same. Methodology: One hundred and fifty-six new patients presenting to the telepsychiatry outpatient were evaluated for suicidal behavior using a semi-structured interview, and severity of illness was assessed by using Clinical Global Impression (CGI) scale. The actions taken by the clinicians in the face of suicidal behavior were also documented systematically. Results: The study included 156 adult patients (aged >18 years), with more than half of the patients diagnosed with either depressive disorder (27.4%) or anxiety and stress-related disorders (30.8%). As per CGI, majority of the patients were either moderately ill (64.7%) or mildly ill (17.3%). In terms of suicidal behavior, in the last few weeks prior to assessment, 18.6% of the patients had death wish, 3.8% had thoughts of killing themselves, 2.6% had attempted suicide in the lifetime and in the last few weeks, 1.9% had active suicidal ideations at the time of assessment, 1.3% had active suicidal plan, 4.5% of the patients had history of nonsuicidal self-injurious behavior in the lifetime, and 1.3% had nonsuicidal self-injurious behavior in the last few weeks. Based on the suicidality, 3.2% of the patients were asked to report to the emergency immediately, 3.2% were given the next appointment within 72 h, and 10.3% were explained high-risk management. Conclusions: A small proportion of new patients presenting to the telepsychiatry services have suicidal behavior, and there is a need to develop protocol to handle the same.
| Impact of COVID-19 Pandemic on Treatment Seeking in an Outpatient Department-Based Opioid Treatment Center: A Retrospective Study | | |
Mini Sharma, Nitin B Raut, B K Gracy
LHMC, New Delhi, India
E-mail: [email protected]
Abstract
Background: Since December 2019, the world has been affected by the novel coronavirus. COVID-19 has not just affected the health status rather also the freedom, finance, and attitude to seek health facility. The reports from NIDA survey hint toward a rise in opioid use in the states during the pandemic. However, Indian studies have reflected upon the experience of patients attending opioid treatment centers for treatment. The Indian Psychiatric Society (IPS) has also facilitated to ensure harm reduction among opioid users by issuing interim guidelines for opioid substitution. Objective: To study the impact of COVID-19 pandemic on treatment seeking in an outpatient department (OPD)-based opioid treatment center: a retrospective study. Methods: A retrospective study was done for analysis of OPD-based opioid treatment center data of a tertiary care hospital for comparison of pre-COVID-19 (April 2019–March 2020) and during COVID-19 (April 2020–March 2021) OPD visits by opioid users. The OPD visit data were collected including number of visits, total number of buprenorphine tablets dispensed, and the dose of buprenorphine consumed per month. The data collected were further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: During the pre-COVID-19 (April 2019–March 2020) duration, there were a total of 1104 (average: 92/month) OPD visits and 4818 (average: 401/month) buprenorphine tablets were dispensed; while during COVID-19 year (April 2020–March 2021), it was 980 (average: 81.66/month) visits and 5174 (431/month) tables. The results were further compared using paired t-test, which were not found to be statistically significant. Conclusion: Although the pandemic COVID-19 has affected the feasibility to seek treatment in opioid users, it has not significantly affected OPD visits for opioid treatment at our center. Although the policy changes such as IPS interim guidelines for opioid substitution treatment have been an ease to facilitate the harm reduction and treatment-seeking attitude, limitation due to lockdown and transportation have been a hurdle. Further regulations and mobile mental team units may be beneficial to ensure treatment and harm reduction among the opioid users.
| Exploring Interpersonal Relationships: A Grounded Theory Study of Adolescent's (Diagnosed with Functional Neurological Disorder) Interactions with Significant Others | | |
Nikita Bhati, Rachna Bhargava, Rajesh Sagar
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: The early theoretical framework (especially psychodynamic) recognizes the role of disturbances in interpersonal relationship context in functional neurological disorder (FND). It has remained a subject of theoretical and research interest for years. But still, there is no unifying model that explains interpersonal processes that cause the functional neurological condition in adolescents. Objectives: To explore interpersonal relationship processes within significant other adolescent interaction. Methods: A grounded theory study was conducted within the framework of Strauss and Corbin (2015) to gather adolescent's (suffering from FND) interpersonal relationship expectations/perceptions of their significant others. The Thematic Apperception Test was utilized to collect narratives about the interpersonal experiences of the adolescent. Results: The grounded theory study found that the problems of adolescents are associated with experiences of threat (causal category) from significant others. They have caused them self-esteem disturbances (core problem) and affect the development of a clear sense of self. Any negative (real or imagined) interpersonal interactions are likely to activate distressing expectations of self and others, therefore threatening their sense of self. The participants defended against threats from others by using self-protective strategies. The theoretical categories were integrated into forming a substantive theory of protective rebuilding of self (core category). The failure to protect or rebuild their “self” has resulted in the experience of pessimism, negative feelings and affects, falling sick, and transforming self (consequences). Conclusions: The findings suggest that the social cognition perspective may be beneficial in understanding interpersonal experiences with significant others and their effect on the formation of the self in adolescents with FND. Psychotherapeutic interventions, especially targeting the reconstruction of the sense of self, are implicated.
| Rates and Correlates of Lifetime Suicidality in Schizophrenia: Preliminary Findings from a Tertiary Psychiatry Hospital in South India | | |
Harkishan Mamtani, V Senthil Kumar Reddi, Shivarama Varambally, Sydney Moirangthem
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Despite being preventable, suicidality is a major cause of morbidity and premature mortality in schizophrenia. The variability of identified extent of risk and associated factors for suicidality in schizophrenia limits their generalization. Objectives: This study aimed to identify the rates of suicidality, including both suicidal ideations and attempts, across the lifespan of schizophrenia patients, and evaluate the correlates associated with it. Methodology: A retrospective chart review of 100 randomly selected patients, diagnosed with schizophrenia between October 2016 and December 2020, was undertaken to identify the prevalence of suicidality and associated sociodemographic and clinical correlates. Comparisons were made of these correlates between those with lifetime suicidality, against those without. Results: The majority of our cohort of schizophrenia patients were single, having studied up to high school–higher secondary, with an insidious onset and continuous course of illness and well-adjusted premorbid personality. The prevalence of lifetime suicidality in them was 44%, with 36% and 24% having suicidal ideations and attempts, respectively. Poisoning was the most common method employed to attempt suicide. Among all parameters compared between individuals with suicidality and those without, only family history of suicidality was found to be statistically significant in bivariate analysis (P = 0.046), however, that significance was lost when univariate analysis was carried out (P = 0.056). Conclusion: Family history of suicidality does not just have a biological underpinning but can also be thought of as a psychosocial factor as well. The high rates of suicidality in schizophrenia indicate that the same be incorporated within the routine assessment, as suicide is a preventable cause of death. Early detection of risk for suicidality is essential to minimize morbidity and mortality in schizophrenia, and further studies are warranted to establish risk factors for the same. Mental health professionals and policymakers can play a significant role in curbing suicidal deaths in this vulnerable population.
| Normalization of Violence against Women in India: The Role of Media | | |
Lekshmi Vimala
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Violence against women is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or in private life” by the United Nations. A 2018 analysis by the WHO estimated that nearly 1 in 3 women have been subjected to violence during their lifetime. It is a global concern but especially so in developing countries such as India. It can result in severe physical and mental ill-health among women and also adversely affect their social inclusion. Media with its power as the fourth pillar of the Indian democracy can play a major role in deciding how the mass public view gender roles and violence against women. The media can decide how it intends to portray an incident which can influence personal opinions to policy changes. Methods: Narrative review of the existing literature on theories associated with domestic violence and media representation of instances of abuse. Results: The cognitive bias of “Just World Fallacy,” along with the tough competition among the different media outlets, leads to sensationalization of the incidents and contributes to “victim blaming” and inauthentic description of the event, thus perpetuating stereotypes and biases. Conclusion: This can prove to be an impediment for the women who need support. Hence, effective utilization of media can help in dispelling ignorance about the intricacies associated with abuse and violence perpetrated against women.
| An Exploration of Key Factors in Psychotherapy Training for Personal and Professional Development of Trainees: A Systematic Review of Literature | | |
Megha Sharma, Shabnam Sayeed
Indira Gandhi National Open University, Delhi, India
E-mail: [email protected]
Abstract
Background: The literature on clinical training lacks the identification of factors that are most relevant in the training program. A large number of studies done in the area of psychotherapy supervision and training were mainly focused on teaching different therapy techniques such as psychodynamic therapy, cognitive behavioral therapy, and interpersonal therapy. Rarely, there is a consideration in the past of the curriculum dedicated to developing in psychotherapist trainees the capability for optimal functioning in personal and professional arena. A number of quantitative and qualitative studies have considered specific aspects of supervision. Objectives: (1) To explore key factors in psychotherapy training for personal and professional development of psychotherapy trainees. (2) To explore how the key factors contribute to positive therapeutic outcomes. Methods: Using a systematic search of the literature involving a mixed methodology and on the basis of inclusion/exclusion criteria was applied. Results: The present paper highlights and discusses about what all key factors are significant in relation to personal and professional development of psychotherapists from the pool of synthesis of findings research studies.
| Assessment of Stigmatizing Attitude toward Depression and its Treatment among Medical and Paramedical Students: An Exploratory Study | | |
Yogender Kumar Malik, Bhupendra Singh, Rajiv Gupta
Institute of Mental Health, PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: The prevalence of psychiatric disorders in medical schools has been continuously increasing, and this could lead to undesirable consequences for the students and their future patients. The use of antidepressants is also increasing with the rise in the rate of psychiatric disorders, in which depression and anxiety are the most common disorders. Despite this, the nonchanging prejudice, self, and public stigma still stand in the way of patients receiving appropriate treatment, especially in traditional societies like India. Although many studies show public levels of depression and general perceptions of depression, studies focusing on antidepressant knowledge and stigma are very limited worldwide. Till date, no such study has been done in Indian medical school population. Hence, this study aimed to assess the awareness of antidepressants and stigmatizing attitude toward depression and antidepressants among medical and paramedical students in a tertiary care teaching hospital. Objective: To assess stigmatizing attitude toward depression and its treatment among medical and paramedical students in a tertiary care teaching hospital. Methods: These results are a part of larger study. The Google Forms was created, and data collection was conducted through anonymous questionnaires shared through online platforms that included 474 students. All students who agreed to take part in the study completed the online questionnaire including sociodemographic details. All participants were assessed for depression, anxiety, and stress symptoms, antidepressants awareness, and stigmatizing attitude toward depression and antidepressants by using a 21-item Depression Anxiety Stress Scale and 28-item self-administered Depression and Antidepressants Knowledge and Awareness Scale, respectively. Results: In the study population, the mean age was 22.19 (standard deviation: 2.58; range: 18–38). 80.4% of participants were medical students and 19.8% of participants were paramedical students. Further details of results will be presented at the time presentation. Conclusion: There are needs to be emphasis on the medical education, seeing mental health problems as an illness, their victims as patients and seeing antidepressants as a method of treatment might help in changing stigmatizing views.
| A Cross-Sectional Study of Internet Addiction among Resident Doctors | | |
Swati Sharma, Dinesh Kataria, Shiv Prasad
E-mail: [email protected]
Abstract
Background: Internet addiction is one of the fastest-growing addictive behaviors and is a significant public health problem. About 42 million active Internet users in urban India were there in 2008 as compared to 5 million in 2000. In contemporary society, approximately 40% of the world population is online. Internet use or addiction comes under behavioral or process addiction which comprises a series of potentially pathological behaviors that expose individuals to mood alternating events by which they achieve pleasure and become dependent. Objectives: To study the prevalence and pattern of Internet addiction among resident doctors in a medical college. Methods: A cross-sectional study was conducted among resident doctors of different specialties via Google Forms. Residents who have been using the Internet for at least 12 months prior to the study were included in the study. A total of 150 residents who gave informed consent and submitted their response were considered for the study. Semi-structured questionnaire along with 20-item Internet Addiction Scale was administered. The data were analyzed using SPSS. Results: Results will be displayed at the time of presentation. Conclusions: Internet addiction was found to be substantial among resident doctors and most commonly for social networking. Availability of high-speed Internet on mobile phones may be the reason for spending more time on social network websites.
| “Psychic Pain Leading to Injecting Drug Use:” Nalbuphine Dependence in a Middle-Aged Woman with Somatoform Disorder: A Case Discussion | | |
Ankita Chattopadhyay, Ragul Ganesh, Koushik Sinha Deb
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: Nalbuphine, a low potency opioid, has been widely used in postoperative and obstetric analgesia, with few reports being available of its potential to be abused in Southeast Asian countries. Aim: We, hereby, present the description and management of a middle-aged woman, who was suffering from somatoform disorder and subsequently found to be dependent on nalbuphine. Methods: A 45-year-old homemaker presented to psychosomatic clinic, with complaints of multiple somatic pains. Detailed history taking and examination were done for evaluation. Results: Detailed history revealed onset of somatic pain symptoms for 2 years, starting with episodes of headache and lower back pain, for which she would consult multiple local physicians and would be prescribed symptomatic relief with nonsteroidal anti-inflammatory drugs. With increasing number of stressors in her household, the pain aggravated. Multiple fresh and old healed puncture marks led us to one instance of severe low back pain, when she was administered intravenous nalbuphine by a local pharmacist. Experiencing relief in pain and euphoria, she would get herself injected with nalbuphine on instances of back pain or headache, which gradually increased to 2–3 times daily. The patient would typically describe an irresistible urge for the medication as well as withdrawal symptoms in the drug-free period. She was subsequently detoxified with tramadol and started on opioid antagonist naltrexone. For her somatic symptoms, she was given a trial of duloxetine which failed and subsequently she responded to mirtazapine. Currently, she is maintaining well with cognitive behavioral therapy as well as relapse prevention therapy sessions being continued on an OPD basis. Conclusion: This case demonstrates how somatic symptoms in a middle-aged woman lead to opioid dependence along with injecting drug use which brings in severe health risks. It also makes it clear that screening for substance use and checking for physical findings for the same is crucial as female patients might not disclose it themselves with factors such as stigma and discrimination playing in the background.
| Consultation–Liaison Psychiatry: Nonpsychiatry Clinicians Views toward Psychiatry Referral in Tertiary Care Hospital in North India | | |
Kashypi Garg
Teerthanker Mahaveer Hospital, Moradabad, Uttar Pradesh, India
E-mail: [email protected]
Abstract
Background: Consultation–liaison psychiatry (CLP) is a relatively young and upcoming subspecialty of psychiatry. There is a need to establish healthy communication and relation among psychiatry and other areas of medicine in keeping up with the recent trends of medical care. Objectives: (I) to study the attitude of clinicians of various fields, other than psychiatry toward referral of psychiatric patients, and (II) to study their views toward CLP as a separate field in hospital settings. Methods: A semi-structured questionnaire was given to faculty including senior residents and higher faculty clinicians in a tertiary care teaching hospital. A structured questionnaire consisting of 14 items was used. Permission for redistribution was taken from the original author. A total of 105 responses were collected. Results: The study reveals 40%–50% of the patients referred to psychiatry with symptoms of anxiety, the sadness of mood, and other unexplainable nonphysical symptoms by other nonpsychiatric clinicians. Significant psychiatric referral rates from various fields such as medicine, surgery, orthopedics, and other superspecialty clinics for complaints of anxiety, depression, or organic brain syndromes. Conclusions: CLP is the communication and cooperation which facilitates a close working relationship between people and organization. Patients are referred to if the treating clinician recognizes psychiatric comorbidity or a psychological problem, or if he feels the patient may benefit from a psychological evaluation. Currently, the attitudes among general physicians toward patients with psychological problems are changing in India.
| Burden of Care among Caregivers of Patients with Alcohol Use Disorder | | |
Satyabhama Nayak, Sunila, Vikash R Shrama, Rajiv Gupta
Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: Alcohol dependence has been a major social and personal threat in most countries. Family burden is the extent of suffering experienced by the family of a patient due to various problems encountered with regard to financial condition, routine family interaction, and physical and mental health of other family members. Objective: Study objective was to assess the family burden of caregivers of alcohol-dependent patients and to find out the significant difference between different groups of the various sociodemographic variables of the caregivers of alcohol-dependent patients regarding family burden. Methods: A cross-sectional study was conducted to assess the burden of care among caregivers of patients with alcohol use disorder, attended State Drug Dependence Treatment Center, PGIMS, Rohtak, Haryana. Data collection was done by administering the Family Burden Interview Schedule on 33 caregivers of alcohol-dependent patients. Mann–Whitney U-test was performed to know the significant difference between groups of each sociodemographic variable with regard to family burden total score. Results: The test revealed significant differences between those caregivers who are in their early adulthood (median = 27) and middle adulthood (median = 31) (U = 67.00, z = −2.463, P = .014, t = 0.18). However, there was no significant difference found between caregivers who were male and female (U = 78.00, z = −0.140, P = 0.888, t = 0.000); unmarried/widow and married (U = 67.50, z = −1.368, P = 0.171, t = 0.056); joint and nuclear family (U = 130.50, z = −0.091, P = 0.927, t = 0.000); and rural and semi-urban/urban locality (U = 125.50, z = −0.019, P = 0.985, t = 0.019) with regard to family burden. Caregivers of patients with alcohol dependence reported a significant objective and subjective burden of care. Conclusion: Caregivers who were in their middle adulthood were experiencing higher family burden than who were in their early adulthood. The current study has illustrated that all the caregivers experienced a significant amount of burden which has to be addressed for better treatment outcome of the patients.
| Emotional Disturbance, Depression, and Resilience Coping among Medical and Nonmedical Professionals during COVID-19 Pandemic | | |
Shabnam Ara, Pradeep Kumar, Arshid Hussain, Hitesh Khurana, Yasir Rather, Prerna Sharma
E-mail: [email protected]
Abstract
Background: COVID-19 pandemic appeared all of a sudden and created a challenge for medical professionals as well as common men. Due to uncertain methods of its treatment and prevention, it continues to question the capabilities of medical professional and existence of humanity. In most of the people, it created symptoms of stress and anxiety. People exposed to such stress cope with it differently that may either lead to decompensation or continue to struggle and protect themselves with resilience. Little is known if the professional knowledge help coping with stress due to pandemic, hence this study is taken up. Objectives: (1) To explore and compare severity of symptoms of stress due to COVID-19, depressive symptoms, and coping among medical and nonmedical professionals. (2) To explore and compare the severity of symptoms of stress due to COVID-19, depressive symptoms, and coping among males and females. Methods: This was an online survey designed to explore symptoms of anxiety, depression, and coping abilities among medical and nonmedical professionals. Standard instruments such as Brief Resilient Coping Scale, PROMIS Emotional Distress-Depression-Short Form, and a self-designed questionnaire to explore COVID-19-related concerns were used. The study was granted ethical approval from Jammu University. Results: A total of 150 responses were obtained; the incomplete responses were managed by pair-wise deletion. At the end, 137–146 responses were available for analysis. The medical and nonmedical professionals showed high but statistically nonsignificant COVID-related concerns, mild anxiety, and depressive symptoms with good resilient coping abilities. The females showed significantly more depressive symptoms. Conclusions: Awareness and practice of medical knowledge does not offer any advantage in coping. Females manifest more depressive symptoms. Both these findings suggest need for psychological interventions for medical professionals as well as community dwellers (288 words).
| Sex in Mind: A Confluence of Behavioral Addiction, Organic Brain Changes, and the Curiosity | | |
Asish Asutosh Choudhury, Shree Mishra
AIIMS, Bhubaneshwar, Odisha, India
E-mail: [email protected]
Abstract
Background: Often, children are the unfortunate victims of the protracted sequelae of encephalitic brain damage. Growing up and exploring sexuality in a prosocial behavioral context is often challenging not only with regard to the difficult symptoms per se like hypersexuality but also the challenging social acceptance and accommodation of such symptoms by peers, school, and family resulting in a restrictive growing up experience. The alteration of the reward pathway also makes them vulnerable to digital/pornography addiction which can further perpetuate these sexual behaviors. Nonetheless, the early adolescent curiosity and experimentation in a backdrop of disinhibition make them vulnerable to abuse. Objective: To understand the challenges and management of organic brain sequelae in a psychosexual/social context. Results and Conclusion: Organic brain syndromes, especially hypersexuality, obsessive–compulsive, and behavioral (pornographic addiction), warrant an in-depth conceptualization. Onset at early age complicated with the adolescent inherent curiosity and experimentation can give it a difficult trajectory. Often, social isolation, low self-esteem, and removal from school can hamper the prognosis. Social acceptance and awareness about organic sequelae in education institutes can promote holistic care and rehabilitation of the child.
| A Cross-Sectional Study of COVID-19-Related Stigma among the Affected Individuals | | |
Nimmy Chandran, V G Vinuprasad, C Sreedevi, Sajal Sathiadevan
Government Medical College, Palakkad, Kerala, India
E-mail: [email protected]
Abstract
Background: The studies and case reports from various parts of the world are showing discrimination and stigma associated with COVID-19. Stigma can lead to many deleterious effects on the health of persons affected and others. People can avoid testing and may not disclose the information or seek treatment due to fear of stigmatization and discrimination by others. This can lead to more spread of illness and deterioration of the health of affected persons without proper treatment. Stigma can also act as a risk factor for anxiety and depression of the affected individual and nonaffected individuals. This study aimed to assess the perceived and experienced stigma associated with COVID-19 in affected individuals. Methods: This was a cross-sectional study conducted at Government Medical College, Palakkad, from December 1, 2020, to June 21, 2021. Study participants included COVID-19-diagnosed patients. Participants were admitted patients and patients under home care after getting negative COVID-19 results, and COVID-19-diagnosed patients under home care. Participants gave online consent to participate in the study and were all >18 years of age. The sampling method was convenience sampling. The survey questionnaire was either sent to the participant's mobile numbers or completed via a telephonic interview with participants. The COVID-19-Related Stigma Survey Questionnaire was prepared by experts from the field of psychiatry and community medicine. Results: Among the total participants (n = 303), 80 participants (26.4%) wanted to keep the illness a secret, and 39 participants (12.9%) probably wanted to keep the illness a secret. Thirty-four participants (11.2%) had a fear of discrimination and 47 participants (15.5%) had doubts about discrimination. Eighty-nine participants (29.4%) had experienced stigma related to their COVID-19 infection. Seventy-five (24.8%) participants' family members had experienced stigma. Conclusion: Definite measures need to be taken to reduce the stigma related to COVID-19 infection.
| Meditation-Related Psychosis and Contentious Issues: A Case Report | | |
Gaurav Kachhawaha, Gurveen Bhatia, Snehil Gupta
AIIMS, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Background: Yoga and meditation (henceforth meditation) apart from promoting general well-being also have therapeutic roles in physical and mental illnesses. However, few case reports highlight unwanted/adverse psychological effects (APEs) such as psychosis, mania, depersonalization–derealization, and traumatic memories related to them. Objectives: To highlight the interplay of onset of psychosis and characteristics of the meditation practice and biopsychological contributors. Methods: Through the two case reports, we intend to highlight meditation-induced psychotic states and discuss relevant issues. Results: While the first case is of a 20-year-old female with an illness of acute onset and a duration of 2 months, the second case pertains to a 40-year-old female, practicing meditation for the last 4 years, but indulged in unsupervised practice for the last 2 months, and developed an insidious onset illness and of 1.5-year duration. Symptomatology of both the cases was similar (delusions: grandiosity, persecution, reference, and third-person auditory hallucinations), but there were differences concerning the age of onset, the interval between initiation of meditation and onset of illness, duration of practice, and each session of practice. Some pieces of evidence could explain the interplay of meditation in the induction of psychotic states in both cases. Discussion: Risk factors for APEs are intensive meditation, higher frequency of practice, family history, psychiatric, medical, and trauma history, motivations or goals for meditation, personality, etc. Some of the proposed mechanisms include increased serotonin-rec-2 activation, increased 5-methoxy dimethyltryptamine, increased N-Acetyl-aspartyl glutamic acid, increased dopamine, and transient prefrontal cortex deregulation (abnormal synaptic connectivity and neuronal thickness of PFC in schizophrenia). Conclusions: Meditation, particularly unregulated and unsupervised practice, can lead to psychosis in vulnerable populations. Future research should be conducted to delineate these risk factors and come up with prescriptive guidelines to prevent and manage such adverse events.
| MEHAC's Virtual Route to Care during Pandemic: An Opportunity to Recapitulate Sustainability | | |
Poornima Sunder, S Anitha, Anupama V Prabhu, M Arun, Anita Rajah, Roshni Robins, Chitra Venkateswaran
MEHAC Foundation, Kochi, Kerala, India
E-mail: [email protected]
Abstract
MEHAC's model of care delivery has enabled it to make affordable mental health care accessible to people, especially in low-resource communities of Kerala. The pandemic has mandated rapid adaptations to delivery of outpatient and home care services for individuals with mental health issues and their families. During the crisis, beneficiaries in the health-care system are particularly vulnerable and alterations in the care delivery have tremendous implications for them. To tackle the current situation, alternative approaches in service delivery were adopted. This paper aims to provide an overview of how MEHAC adopted a virtual route to care along with the existent model. MEHAC's functioning is based on the principles of relationship-based connectedness, prioritizing compassionate holistic care delivered by a multidisciplinary team with focus on well-being. This included outpatient services and home visits requiring average travel of 50–60 km/day. The prevailing constraints imposed by pandemic forced us to explore a remote mode of operating, using Information and Communication Technology. Mobilizing existing ground support, empowering stakeholders, and increased use of electronic records were some steps taken to foster this approach. This shift enabled 100% follow-up, faster and more efficient communication, and better delivery of biopsychosocial care. This paper will focus on the challenges faced, the repositioned model of care, and significant insights gained due to this adaptation.
| Needs of Patients with Common Mental Disorders: A Comparison of Two Treatment Settings | | |
Varun Mehta, D Ram, Smita Deshpande, Triptish Bhatia
Central Institute of Psychiatry, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Background: National Mental Health Survey estimates that about 10% of population suffers from common mental disorders (CMDs). Their chronicity could result in many needs to be unfulfilled such as basic needs, health needs, and social needs. However, such needs have not been systematically studied and the focus seems to be tilted toward severe mental illnesses. Objectives: To estimate and compare the unmet needs of patients with CMDs visiting the community extension clinics (CECs) as well as the institute as a part of a larger research project. Methods: The eligible participants were recruited from the CECs as well as the institute outpatient services receiving any of the diagnoses from the International Classification of Diseases (ICD)-10 belonging to the group of CMDs (F32.x, F33.x, F34, F40.x, F41.x, and F45.x) of either sex between 19 and 50 years. The diagnosis was ascertained using the Hindi version of the Mini-International Neuropsychiatric Interview v5.0 for ICD-10. The diagnosis-specific rating scale was administered for the severity of symptoms. The assessments of needs were done using the scale of Camberwell Assessment of Needs-Research. The total number of met needs and unmet needs gave information about the total number of needs. Results: The patients visiting the CECs had a significantly later age of onset (P = 0.020), longer duration of illness (P = 0.006), lesser severity of symptoms of depression (P < 0.001), anxiety (P < 0.001), more met needs (P = 0.018), and less unmet needs (P < 0.001) in comparison to the patients visiting the institute. The major unmet needs were in the domains of psychological distress (65.5%), looking after home (51.5%), and daytime activities (45.3%) for all the patients. Conclusions: These needs underscore the heterogeneity among various patient groups as well as the varying treatment settings run by the institute. People with unmet needs are likely to experience a poor quality of life and need reorientation of the mental health service to address their reported needs through multilayered and multisectoral responses.
| Prevalence and Correlates of Loneliness in Patients with Schizophrenia | | |
Aarzoo Suman, Ritu Nehra, Sandeep Grover
Post Graduate Institute of Medical Education and Research, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Loneliness is one of the feelings that could be encountered during any phase of schizophrenia. Studies have explored that patients with schizophrenia feel more lonely as compared to healthy controls. There are limited data on the prevalence and correlates of loneliness in patients with schizophrenia. Objective: To evaluate the prevalence and correlates of loneliness in patients with schizophrenia, currently in clinical remission. Methodology: One hundred and sixty patients of schizophrenia in clinical remission were assessed on the UCLA Loneliness Scale, Positive and Negative Scale for Schizophrenia, Calgary Depression Scale for Schizophrenia, Internalized Stigma of Mental Illness Scale (ISMIS), Rosenberg Self-Esteem Scale, Brief Cope, Beck's Hopelessness Scale, Brief Dyadic Scale of Expressed Emotions, and Self-report Quality of Life Measure. Results: The mean age of the study sample was 34.99 (standard deviation: 9.13) years. Males outnumbered females. Four-fifth (80%) of participants fulfilled the criteria of loneliness, and the mean score of UCLA-loneliness scale score was 30.04 (16.90). Compared to participants without loneliness, those with loneliness had a longer duration of illness, were on treatment for a longer duration, had higher scores on depression scale, had a higher prevalence of depression, poor quality of life in all the domains, lower self-esteem, and higher prevalence of below-average self-esteem, higher prevalence of stigma and higher scores in all the domains of ISMIS except for stigma resistance, higher level of expressed emotions in all the domains, more frequent use of maladaptive coping strategies such as self-distraction, denial, behavioral disengagement, self-blaming, and a higher level of hopelessness. Conclusion: There is a high prevalence of loneliness in patients with schizophrenia, and there is a need to routinely evaluate the patients of schizophrenia for loneliness and address the same.
| Introducing Integrative Community Therapy in North America: A Web of Solidarity Care | | |
Kenneth Thompson, Alice Fox Thompson
Visible Hands Consulting, Pennsylvania, USA
E-mail: [email protected]
Abstract
Background: Even before the pandemic, Americans experienced a mental health crisis due to extensive social dislocation with a related lack of social support. Barriers to mental health care, including the limitations of clinical care itself, leave many unattended. Integrative community therapy (ICT), a large group dialogic therapeutic method developed in the favelas of Brazil, addresses just this challenge. It provides mental and emotional health support through community dialog. Based on Paulo Freire's pedagogical theory in which horizontal relationships facilitate learning and emotional solidarity, ICT can be provided by nonprofessionals as part of whole-person primary care. This presentation will describe an effort to translate ICT to the USA, its successes and challenges and implications for future expansion. Objectives: To identify the need for ICT in North America; to explain the challenges of introducing ICT in North America's cultural context; to describe the implementation of the first virtual ICT training in English; to review the training successes and challenges; to discuss plans for bringing the intervention to scale. Methods: An 88-h virtual training using didactics and practice “rounds” was implemented from January to March 2021. Trainees were then required to complete 15 practice rounds within 1 year of completion of the training while under ongoing supervision. Results: With foundation support, 35 students, 50% of whom are practicing mental health professionals, completed the training and entered into the practicum portion of the certification process. Eight students were from Pittsburgh, with 27 students from across the US, Canada, and Switzerland. Numerous organizations and foundations are interested in replicating and expanding these results. Conclusions: ICT is a promising practice of nonclinical “solidarity care” where the community is the therapy. If brought to scale, it has the potential to promote mental health and reduce psychiatric morbidity, lessening the burden on clinical services.
| A Qualitative Study on Psychological Well-Being and Burden among the Caregivers of Schizophrenia and Bipolar Affective Disorder in Lower Socioeconomic States of India during COVID-19 Pandemic | | |
Aina Kumar
Central Institute of Psychiatry, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Background: Caregivers play a vital role in enabling holistic support toward the family member who suffers from various severe mental illnesses. In this study, the main focus is to measure the level of psychological well-being and burden among caregivers of patients with schizophrenia and bipolar affective disorder during pandemic situation in lower socioeconomic states such as Jharkhand, Bihar, and Odisha. Methods: A total of 100 caregivers of patients with schizophrenia and bipolar affective disorder attending the outpatient clinic of central institute of psychiatry were selected randomly for the study. Structured interviews were conducted by using burden assessment schedule and psychological general well-being index. The data obtained were analyzed using the Statistical Package for Social Sciences version 21. Statistical significance was set at 5% level of probability for the study. Results: The results indicate that there is no significant difference between the psychological well-being and burden among the caregivers of schizophrenia and bipolar affective disorder. Conclusion: The positive relationship between burden and psychological well-being of caregivers has been qualitatively analyzed in many previous studies, and interventions have been designed accordingly, but the COVID-19 pandemic situation has bought an entirely different framework with respect to the abovementioned factors. Hence, the findings of this study help in emphasizing the need for interventions in building efficient coping skills specifically for caregivers of individuals with severe mental illness in the current COVID-19 pandemic situation in lower socioeconomic states of North India.
| The Spectrum of Behavioral Problems in Children with Epilepsy | | |
Rashmi Singh, Neena Sawant
Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
E-mail: [email protected]
Abstract
Background: Various psychiatric comorbidities have been reported in children with epilepsy (CWE), but Indian data on the same are lacking. Objective: This study was undertaken with the aim to find the prevalence and type of behavioral problems in CWE. Methods: Sixty-five patients of CWE and 65 controls were recruited after ethics approval and parent consent. All children were interviewed and diagnosed for psychopathology as per the International Classification of Diseases (ICD)-10 criteria. The Strengths and Difficulties Questionnaire (SDQ), a behavioral screening questionnaire, which assesses the behavior, emotions, and relationships in children aged 4–16 years was also given to parents. Data collected were analyzed further. Results: As per ICD-10 diagnosis, behavioral disorders were seen in 44.6% of CWE as compared to 12% of control group. The types of disorders in CWE and control group were disturbance in activity and attention in 34% and 7.6%, hyperkinetic conduct disorder in 3% and 1.5%, unsocialized conduct disorder in 7.6% and 3%, oppositional defiant disorder in 11% and 6%, and nonorganic enuresis in 28% and 17%, respectively. On SDQ, a significant difference was seen on domains of hyperactivity and prosocial behavior in CWE as compared to controls whereas emotional, conduct, peer problems, and total difficulty score revealed no significant differences in both groups. A comparison of internalizing and externalizing problems on SDQ in both the groups revealed significant externalizing behaviors in CWE. Conclusion: Significant behavioral disorders are seen in CWE which entails the need to have a multidisciplinary approach for early diagnosis and better control of symptoms.
| Insight in Schizophrenia and its Relation with Psychopathology and Frontal Lobe Function | | |
B Rakesh, B Srinivasan, O T Sabari Sridhar, S Kailash, Z Shabeeba
Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Insight in psychiatry is considered a multidimensional concept referring to the patient's judgment and attitudes toward his illness. Lack of insight is a core feature of schizophrenia. Cognitive impairment in schizophrenia is attributed to the frontal lobe dysfunction. Hence, poor insight is also linked to the frontal lobe dysfunction. Objectives: The objective of the study was to determine the insight and its correlates in patients with schizophrenia and compare the relation of insight to that of psychopathology and frontal lobe function. Methods: Seventy patients diagnosed with schizophrenia meeting the inclusion and exclusion criteria were included in the study. The study was conducted at the department of psychiatry in a tertiary teaching hospital. Sociodemographic and clinical variables were collected. Psychopathology and symptom severity were assessed using the Positive and Negative Syndrome Scale (PANSS). Insight was measured using the Schedule for Assessment of Insight-Extended version (SAI-E). Frontal lobe executive function was tested using Wisconsin Card Sorting Test (WCST), and Digit Span test of Wechsler Adult Intelligence Scale. Association between SAI-E and PANSS, WCST, and digit span was assessed by determining the Pearson correlation coefficient. Chi-square test was used to test the statistical significance. Results: 67.1% of the study population had no insight. Level of insight directly correlated with the severity of symptoms. Longer duration of untreated psychosis was associated with poor insight. There was a significantly higher score in domains of positive symptoms, negative symptoms, and general symptoms among those with no insight compared to those with insight (P < 0.001). The performance on the Wisconsin Card Sorting Test and Digit Span Test directly correlated to their insight. Conclusion: This study has reiterated that insight is multidimensional in nature. The nature as well as severity of symptoms and frontal lobe dysfunction is implicated for poor insight among patients with schizophrenia.
| Profit Distribution for Patients Involved in a Day-Care Work Program at a Tertiary Mental Health-Care Institute | | |
Amrita Roy, Bhaswati Kalita, T. Sivakumar, Deepak Jayarajan
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Green Skills Program run at Psychiatric Rehabilitation Services (PRS), NIMHANS, involves patients in making eco-friendly products (Holi kits, Diwali kits, and eco-pens) and shares profits from sales proceeds to reinforce their work productivity. The share of profits is in addition to the monthly incentives received by the patients for attending the day-care services. Aim: To provide an experiential account of calculating and distributing the profits among the patients. Methodology: Descriptive approach is adopted to discuss the strategy adopted to calculate and distribute the share of profits during two consecutive financial years (FYs) 2017–2018 and 2018–2019 and our subjective experiences of being involved in this profit distribution process. Results: Profits of ₹30,000 and ₹128,200 were distributed among 26 and 34 participants in FY 2018–2019 and FY 2018–2019, respectively. Participants were divided into groups as per their overall work performance in FY 2017–2018. Whereas, in FY 2018–2019, a performance-based point system was used. This strategy was comparatively more objective in terms of taking into account the contribution and performance during each phase of the production process. The share of profits for each individual ranged from ₹100 to ₹2400 in FY 2017–2018 and ₹500 to ₹8,600 in FY 2018–2019. The profits were shared in cash or kind during public events organized in April 2018 and June 2019 at PRS. Conclusion: Apart from positively reinforcing work participation, profit sharing also addressed “need for income” and “need for social recognition” for many patients. A key dilemma was if profit share per patient should be decided according to work productivity or efforts put in despite limitations.
| Understanding the Dynamics between Stress Anxiety Depression and Body Mass Index among Young Indian Adult: A Quantitative Study | | |
A R Alagarsami
Central Institute of Psychiatry, Ranchi, Jharkhand, India
E-mail: [email protected]
Abstract
Background: Common mental disorders are more frequent and very much associated with obese and underweight young adults in India. The National Mental Health Survey of India 2015–2016 also shows alarming results toward the mental health of young adults. This study will help us to examine evidence to address these assumptions and discuss their psychological implications, rather stigmatization of obese and underweight individuals threatens health, generates health disparities, and interferes with effective obesity and underweight intervention efforts. Materials and Methods: Through a cross-sectional survey, a total of 1004 college-going students of various educational streams across India were assessed for body mass index (BMI) and the level of stress anxiety and depression through the Depression Anxiety Stress Scale-21. The study was analyzed using SPSS 21. Results: Majority of the participants fall under 19–25 years of age group where most of them are female participants (62.1%). While the statistical data show that there is a significant mean difference between BMI categories and stress (P = 0.018) and depression scores (P = 0.011). Conclusion: Prevalence of stress and depression is more among young adults based on their BMI while a significant proportion among young adults, especially among students, has to be made that they have to maintain a healthy lifestyle in order to prevent certain from certain mental health issues. These results also shed light on the dynamic interaction of these variables and how it is important to understand them in order to effectively maintain physical and mental health in young Indian adults.
| To Study the Prevalence of Depression and Anxiety among Cancer Patients, North India | | |
Pushpa Oraon, Neha Bharti
Shri Mata Vaishno Devi College of Nursing, Katra, Jammu and Kashmir, India
E-mail: [email protected]
Abstract
Background: Depression and anxiety do not seem to be uncommon among people diagnosed with cancer. Objectives: This study assesses the prevalence of depression and anxiety among cancer patients and determines the association between depression and anxiety among cancer patients with their selected sociodemographic variables. Methods: An institution-based descriptive study was conducted on cancer patients who are getting treatment and have followed up at the oncology day care unit of the Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Katra, Jammu. A total of 154 patients from the period April 2019 to March 2020 were interviewed using the questionnaire of the Hospital Anxiety and Depression Scale (HADS). The HADS was administered at one point only. Results: Of 154 cancer patients, 77.3% of patients had clinical symptoms of anxiety and borderline anxiety. Anxiety was highest among the patients with the young group, unmarried female cancer patients, those with no formal education, those who had a low monthly family income, and residents in rural areas. The proportion of anxiety was found to be highest among endocrine system cancer patients (61.9%) and reproductive system cancer patients (55.4%). Nearly 60% of them had been receiving chemotherapy for 1–2 years before the day of the interview. The study revealed (clinical symptoms of depression and borderline depression) was present in 68.8% of the sample. Depression was also highest among the same demographic variables as anxiety. The only difference depression was found to be highest among urinary system cancer patients (55.6%) and musculoskeletal system cancer patients (54%). Conclusion: This study clearly shows that the younger age group, female, no formal education, being single, and low monthly income were associated with anxiety and depression. Prepsychological counseling and continued screening for anxiety and depression are essential as an important approach for cancer care to maintain the standard of life in these patients.
| Marital Adjustment and Quality of Life in Wives of Patients with Depressive Disorder | | |
Nandini Lamba, Rajiv Gupta
Pandit Bhagat Dayal Sharma Institute of Medical Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: In India, 1 in 20 Indians suffers from depression. Marital adjustment is the state of overall feeling between husband and wife of happiness and satisfaction in their marriage and with each other. Quality of life is affected by a person's physical health, psychological state, level of independence, social relationship, and environment. Objective: To assess the marital adjustment and quality of life in wives of patients with depressive disorder. Methods: Fifty wives of patients with depressive disorder as per the International Classification of Diseases (ICD)-10 criteria were taken. Various sociodemographic and clinical variables were collected using a pro forma, especially designed for this study. Patients were assessed as per ICD-10 criteria depressive disorder. Their wives were assessed for marital adjustment and quality of life by using the Hindi version of the Marital Adjustment Questionnaire and WHOQOL-BREF, respectively. Results: Among the study population of 50, 29 (58%) participants had poor marital adjustment. In quality of life of the wives, the most affected domains were physical health and social relationship. Conclusion: Depressive disorder in a male patient impairs the marital adjustment and several dimensions of quality of life in their wives.
| Psychosocial Profile and Associated Psychiatric Comorbidity in Male Patients with Dhat Syndrome | | |
Tushar Jagawat, Ashish Bhandari
Jaipur, India
E-mail: [email protected]
Abstract
Background: Dhat syndrome or “semen loss anxiety” is a culture-bound syndrome, characterized by discharge of whitish fluid or semen in urine. From many Asian countries around the world, it has been described, with majority of the literature emerging from India. This is mainly related to the presence of phosphates or oxalates in the urine and misinterpreted as semen by the patient. Objectives: To study the psychosocial profile and psychiatric comorbidity in male patients with Dhat syndrome. Methods: After taking permission from the Scientific and Ethical Committee of National Institute of Medical Sciences and Research, Jaipur, and on the basis of inclusion and exclusion criteria, 120 male patients were included in the study. Written consent from the patient was obtained after explaining the study to the patient. Diagnosis of Dhat syndrome was made according to the International Classification of Diseases-10 classification. The patient was given a semi-structured pro forma designed, especially for the study. The patient's socioeconomic status was evaluated using the B. G. Prasad's Socioeconomic Scale. The Hamilton Rating Scale for Depression was applied to record the severity of depression, the Hamilton Rating Scale for Anxiety was applied for measuring the severity of anxiety, and the Yale–Brown Obsessive–Compulsive Scale for severity of obsessive–compulsive disorder. Results: Majority of patients belonged to the age group of 20–40 years, were Hindus, hailing from a rural area, were married, having secondary education, were farmers, and were from middle socioeconomic status. Patients had depression more than anxiety disorder and obsessive features. Conclusions: This study highlights the sociodemographic profile, anxiety, depression, and obsession in patients with Dhat syndrome. The patients visiting the OPD for Dhat syndrome should always be enquired for comorbid anxiety, depression, and obsession and treatment offered for the same.
| Idioms of Resilience: Mental Health and Migration in India | | |
Raghu Raghavan, Brian Brown, M Sivakami, Nilesh Gawde, Saba Jamwal, Tejasi Pendse, Jonathan Coope, Andy Barrett
Mary Seacole Research Centre (Mental Health, Culture and Diversity), Leicester, England, UK
E-mail:[email protected]
Abstract
This paper considers the popular notion of resilience and mental health in cross-cultural context. We do so through considering the lived experience of migration of thirty participants in a low-income neighborhood in the city of Pune, India. Our focus is on internal migrant population in India where migration from rural to urban areas is integral to population dynamics. Internal migrants who live in slums experience a higher burden of anxiety and depression. Resilience has proved to be a versatile notion to explain why people are not defeated by hardship and adversity, yet so far, we know little of how it might apply to communities and cultures in low- to middle-income countries. In speaking of their experience of migration and making new lives for themselves, participants referred to a variety of intra-individual and external factors that sustained their resilience. These included acceptances of their circumstances, the importance of memory, hope for their children's education and careers as well as kindness from family friends and community members and aspects of the physical environment which were conducive to an improvement in their circumstances. Therefore, by analogy with the widely used term “idioms of distress,” we advocate attention to the locally nuanced and culturally inflected “idioms of resilience” or “eudaemonic idioms” which are of crucial importance as migration and movement become ever more prominent in discussions of human problems. The nature and extent of people's coping abilities, their aspirations and strategies for tackling adversity, their idioms of resilience, and eudaemonic repertoires are worthy of attention so that services can be delivered so as to genuinely support their adjustment and progress in their newfound circumstances.
| Challenges in Managing COVID Infection in Patients with Mental Illness in Closed Wards | | |
Onshi Taneja, Ravi Prakash, Amit Soni
Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: The COVID-19 pandemic has brought new challenges for the management and treatment psychiatric patients in closed wards. Inpatients in the closed ward with mental illness who get infected with COVID require close monitoring of symptoms, call for early diagnosis and isolation, and daily extensive monitoring. Management of COVID in such patients has some difficulties as in executing the protection policies, regular monitoring, and treatment by clinicians wearing personal protective equipment kits. The patients also have insufficient cognitive abilities to recognize the risk of infection and to actively avoid related activities. Objectives: The study aims to discuss the challenges faced in managing COVID infection in patients with mental illness in closed wards of the Institute of Mental Health. Methods: The patients affected with COVID-19 infection staying in closed wards in the Institute of Mental Health, Rohtak, are included in the study. The study analyzes the problems right from diagnosing to deciding the place of treatment, shifting, and further management of patients admitted in IMH, who unfortunately became COVID positive. The outcome was analyzed in light of gravity of COVID impact in the whole institution. Results: Out of five patients (45%) who developed COVID infection during March–May 2021, three were complete recoveries, one absconded, and one patient was lost due to the post-COVID complications. The average stay in the designated COVID ward was 20 days. Re-emergence of psychiatric symptoms was noted in two patients post-COVID recovery. Conclusion: Vigilance must be exercised by medical specialists and psychiatrists alike while handling psychiatric patients with COVID infection. Provision of separate closed ward facilities with integrated medical and psychiatric teams is required for patients of mental illness.
| Lacunae in Certification of Disability due to Mental Illness in Manipur, India – An Introspection | | |
Rajkumar Lenin Singh, Asheema Haobijam
RIMS, Imphal, Manipur, India
E-mail: [email protected]
Abstract
Background: The Rights of Persons with Disabilities Act 2016 came into force in April 2017. This presentation attempts to bring into focus the lacunae in the certification issued for disability due to mental illness in Manipur and also gives suggestions on how to address this lacuna so that people living with disabilities are able to fully enjoy the benefits and incentives which are rightfully theirs. Objectives: To present a brief literature review on the issues and challenges of disability certification for mental illness with special emphasis on the state of Manipur, India. Methods: Literature available freely on the Internet on disability certification of mental illness in India was searched and analyzed. Documents and information on the certification of disability were obtained from the Social Welfare Department, Government of Manipur, and from the Department of Psychiatry and Clinical Psychology, RIMS, Imphal. Results: Between December 2017 and July 2021, a total of 1961 disability certificates were issued by the Social Welfare Department, and only 198 (10%) were of mental illness. During the same period, 507 certifications were done at the Department of Psychiatry and Clinical Psychology, 189 (37%) were of mental illness, 74 autism, 47 Spatz–Lindenberg's disease, 64 dementia, 2 bipolar affective disorder, and 2 schizophrenia. These certifications at RIMS were not reflected in the government list of disabilities suggesting a disconnect between policies and its implementation. Conclusion: The number of certifications issued for disability due to mental illness is very less in Manipur, which prompts us to give increased attention to narrow this gap in disability benefits and its implementation.
| Going Mobile with “Tobacco Cessation Clinic:” A Pilot Trial of Mobile Phone Technology to Improve Adherence at a Tobacco Cessation Clinic Established amid the COVID-19 pandemic | | |
Aparajita Guin, Aniruddha Basu
All India Institute of Medical Sciences, Kalyani, West Bengal, India
E-mail: [email protected]
Abstract
Background: Tobacco use is the leading cause of preventable death. Each year, it brings out more than 7 million deaths worldwide. It has been also correlated with the COVID-19 pandemic. However, tobacco cessation services worldwide had been affected due to the COVID pandemic. Hence, the Department of Psychiatry at AIIMS, Kalyani, felt the need to establish face-to-face tobacco cessation clinic (TCC) and tele-addiction treatment clinic in the mid of the pandemic and develop innovative techniques for enhancing adherence through mobile phone technology and telemedicine. Objective: To evaluate the effectiveness of pilot intervention comprising an m-health-based reminder to improve the treatment adherence at a newly initiated face-to-face TCC and linking it with tele-outpatient department services. Methods: Consenting patients presenting to TCC, who have access to mobile phones, will be enrolled in the study till August 15, 2021. Assessment of the sociodemographic and clinical profile will be done. Participants are divided into control and intervention groups alternatively using consecutive sampling technique. In the intervention group, initially a SMS reminder will be sent informing them about the physical or tele-follow-up. Patients who would miss the appointment even after the SMS will be given a voice call reminding them about the follow-up. The effect of the interventions will be compared with the control group which will include treatment as usual (no SMS/voice call reminders, only counseling about follow-up at the time of the first presentation). Results: The sociodemographic and clinic profile including treatment outcome which will include retention in services will be noted and compared between the two groups. Discussion and Conclusion: If this pilot intervention proves effective, then it will be easy to convince and adopt these low-cost interventions in the index hospital as a routine measure.
| Treatment Engagement of Persons with Severe Mental Illness: Perspectives of Community Nurses, Karnataka, India | | |
S Revathi, Deepak Jayarajan, Sailaxmi Gandhi, N Manjunatha
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Treatment gap for severe mental illnesses is 73.6%, as reported by the National Mental Health Survey in India. Addressing nonengagement to treatment can reduce this treatment gap. The community nurses placed in District Mental Health Program (DMHP) work at the grassroot level, identifying and managing persons with severe mental illness (PwSMI) in rural India. Interventions for treatment engagement that can be used by nurses of DMHP can be formulated by achieving an insight into their views and roles in this area. Objectives: To understand the community nurse's perspectives on treatment engagement in PwSMI. Methods: Qualitative research design was used. Community nurses (36) working in DMHP, Karnataka, and qualified with BSc(N) or GNM were selected using convenience sampling. Eight group meetings (each of 4–5 nurses) were conducted using a semi-structured interview schedule (one online and seven in-person interviews). The audio recordings of the interviews were transcribed, and coded. Themes and subthemes were extracted and analyzed. Results: The themes generated were as follows:
- Reasons for nonengagement: Lack of knowledge, attitude toward mental illness, medication, and patient and systemic issues
- Consequences of nonengagement by PwSMI: Relapse, exacerbation of symptoms, marital conflict, caregiver burnout, and hospitalization
- Interventions to address nonengagement: Educating PwSMI and caregiver, intervening side effects, handling refusal of medications, and dropping out from treatment through phone and home visits
Challenges in implementing interventions for nonengagement: Patient and systemic issues, medication supervision, challenges in initiating depot injections, and home visits. Conclusions: The community nurses intervened by conducting home visits, educating PwSMI and caregivers on importance of medication adherence.4. Implications: Need to develop a range of nursing interventions for treatment engagement of PwSMI, training nurses to facilitate dropped out PwSMI returning to treatment, ensuring adequate stock of psychotropic drugs at primary health center pharmacies.
| Intercultural Communication in Psychiatric Diagnosis and Psychiatric Consultations | | |
Janis Chen, Raghu Raghavan, Brian Brown, Zoe Palfreyman, Nandini Chakraborty
Mary Seacole Research Centre, De Montfort University, Leicester, England, UK
E-mail: [email protected]
Abstract
Background: Cultural knowledge is essential in how psychiatrists assess symptoms, behaviors, and expressions while communicating mental ill-health with patients from diverse cultural backgrounds in psychiatric diagnostic consultation interviews. Psychiatrists follow diagnostic guidelines in making sense of the symptoms; however, the diagnostic categories may perform inappropriately with cultural norms and variables. As a result, patients may receive poor mental health services and outcomes. While most studies have identified that inadequate intercultural communication skills may lead psychiatrists to misjudge patients' mental state, empirical research regarding psychiatrists' specific intercultural communication skills required in their clinical practice in the UK is sparse. Thus, this study was conducted in England, home to millions of diverse cultural and ethnic communities from India and other countries. Objectives: This study explores psychiatrists' understanding of their cultural skills during psychiatric diagnostic consultation interviews and investigates psychiatrists' self-reported cultural factors affecting the quality of diagnostic consultation interviews. Methodology: By employing an interpreted phenomenological analysis approach, this study provides in-depth insights into how psychiatrists make sense of their intercultural clinical experiences in psychiatric diagnostic consultation interviews. Psychiatrists were recruited at Leicestershire Partnership NHS Trust, either British trained or received some of their training abroad. Results: Three superordinate themes were developed from nine individual semi-structured interviews. Theme 1: a psychiatrist as a critical thinker. Theme 2: a psychiatrist as an effective intercultural health communicator. And theme 3: A vulnerable psychiatrist. Conclusion: Psychiatrists may increase their cultural awareness and develop intercultural communication skills, depending on their patients' social-cultural context.
| Training Primary Care Doctors in Psychiatry: Impact of a 1-Year Blended Program for Bihar State of India | | |
Bhavya Bairy, B C Malathesh, Aurobind Ganesh, Channaveerachari Naveen Kumar, Prabhat Kumar Chand, Narayana Manjunatha, Suresh Bada Math, Narendra Kumar Sinha, Sanjeev Arora
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: In order to bridge the huge treatment gap in mental health in Bihar, we planned to harness technology for capacity building in mental health. Objectives: To report the impact of a 1-year blended training program (in mental health) for primary care doctors (PCDs) of Bihar. The aim was to enable PCDs to identify, diagnose, and treat commonly presenting psychiatric disorders. Methods: The program comprised a brief onsite orientation to psychiatric practice at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. This was followed by 10 months of online blended training using the NIMHANS-VKN-ECHO model consisting of 20 fortnightly sessions. Each session lasting 2 h contained a didactic lecture by a psychiatrist followed by case discussions. The Knowledge, attitudes, and practice questionnaire was used prior to the training and repeated every 3 months till the end of the training. In addition to this, self-reporting on the number of psychiatric cases seen during the entire duration of training formed the outcome measures. Results: Out of the 23 participant PCDs, 11 got accredited. The increase in knowledge scores was statistically significant (P = 0.006). There was a progressive increase in the detection of common mental disorders every quarterly (P = 0.001) as well as substance use disorders (alcohol and tobacco) (P = 0.008). A significant increase in the confidence levels in prescribing selective serotonin reuptake inhibitors (P = 0.039), BZDs (P = 0.040), mood stabilizers (P = 0.005), providing de-addiction services for alcohol and tobacco (P = 0.037), and providing brief counselling sessions (P = 0.008) was seen. Total 20,999 patients were catered to in 12 months. This pattern was mainly driven by more identifications of severe mental disorders, common mental disorders, dementias, and substance use disorders. Conclusions: Blended model of remotely training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community.
| Free Sociodemographic and Clinical Profile of Patients with Alcohol Liver Disease Seeking Treatment for their Alcohol Use Disorders at a Tertiary Care Center – A Cross-Sectional Study | | |
Surbhi Sharma, YPS Balhara, Shalimar, Ashwani Mishra
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]
Abstract
Background: This study aimed to explore the sociodemographic and clinical profile of patients suffering with comorbid alcoholic liver disease (ALD) and alcohol use disorder (AUD). It is important to identify and treat the patients of ALD with comorbid AUD to increase the abstinence rates among them and improve prognosis. Objectives: The present study aimed to understand the sociodemographic and clinical profile of ALD patients with respect to their AUD. Methods: It was a cross-sectional observational study. A total of 77 patients of ALD coming to liver clinic, who were diagnosed with AUD as per the Diagnostic and Statistical Manual of Mental Disorders-5, were included in the study. Patients were males and over 18 years. We used a semi-structured pro forma and measured the severity of AUD on Mini-International Neuropsychiatric Interview 7.0.0, module I. Results: The mean age of patients was 45 (±10.5) years, 73 (94.8%) were married, 64(83.1%) were living in an urban area, while 71.5% had passed 10th standard. Sixty-four (83.1%) were using alcohol till 1 year before visiting liver clinic. The mean duration of alcohol use was 20.77 years (standard deviation ± 9). Seventy-two (93.5%) were consuming alcohol on a daily basis. The mean duration of AUDs was 11.93 years (standard deviation ± 9). Fifty-nine (76.6%) patients were suffering from severe AUD. Nineteen (24.7%) patients were in early remission while 18 (23.4%) were maintaining sustained remission. Sixty-two (80.5%) of the total sample did not seek any type of treatment for AUD. Conclusions: More than 90% of ALD patients visiting specialized services have comorbid AUD and it is severe in three-fourth of them. Despite such high rates and severity, only one-fifth of them sought treatment.
| General Population Attitude toward “New Normal” During COVID-19 – A Cross-Sectional Assessment of the Changing Daily Life | | |
Nileswar Das, Ankita Chattopadhyay, Apinderjit Kaur, Siddharth Sarkar
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background and Objectives: The ongoing coronavirus disease (COVID-19) pandemic has affected almost every sphere of human lives, including the normal routine of daily life. The so-called “new normal” has changed the way we live, function, and interact with others. There are many long-term implications of changes in individual beliefs and behaviors including public health measures. This study was aimed to assess the new normal that emerged due to the pandemic. Methods: This was an online survey using “Google Forms” which recruited participants across India via snowball sampling. A 38-item questionnaire was used to assess ten different domains of daily life that were affected during the COVID-19 pandemic. The data collection was done from August 1, 2020, to August 30, 2020 (first wave). Analysis was done using IBM-SPSS v22. Results: Participants (n = 370) with a mean age of 30.2 years were predominantly males (60%), graduate degree holders (35%), and from urban (82%) parts of the country. The majority of the respondents believed that “use of mask” (82%), “social distancing” (79%), and “hand hygiene” (85%) can protect against the spread of the coronavirus. Irrespective of age, gender, or education (all P > 0.05), majority of the respondents believed that regular use of masks (74%), social distancing (60%), online schooling (75%), and online banking (85%) will be our new normal. As part of difficulties associated with the new normal, the majority opined that the restrictions will hamper their daily life enjoyments (62%), livelihood or economy (80%), and will heighten the risk of problematic Internet use (82%). Conclusions: A significant change is expected to happen due to the pandemic as a new normal, including safety precautions, travel restrictions, higher utilization of online services, and reduced in-person interaction. Longitudinal studies will be able to provide further insight into how low- and middle-income countries (LMIC) like India will adapt to such changes.
| Fear and Information-Seeking Behavior Related to COVID-19 in Older Indian Adults | | |
V Sreelakshmi, Suyog Jaiswal
AIIMS, Nagpur, Maharashtra, India
E-mail: [email protected]
Abstract
Background: Older adults are a high-risk population for COVID-19. Pandemic-related restrictions laid several limitations on their daily activities, access to information, and care, making them vulnerable to mental health sequelae. Objectives: Assessing fear and information-seeking behavior related to COVID-19 among older Indian adults. Methods: It was an online, cross-sectional study, and an open-access e-invite to the questionnaire (on Google Forms) was circulated via social media. Responses of adults ≥60 years of age were noted. The form contained sociodemographic details, Fear of COVID-19 Scale (FCV-19S), and an original questionnaire on information-seeking behavior in COVID-19. Data were analyzed using SPSS v20. Mann–Whitney U-test was used to compare the FCV-19S scores among information-seeking variables. Results: Among a total of 150 completed responses, the mean age of the respondents was 67 ± 5.44 years; the median FCV-19S score was 11 with 9.33% of respondents having significant fear related to COVID-19; TV/radio (55.3%) followed by newspaper/magazines (40.7%) was the most preferred source of information; preventive measures (75.3%) and symptoms of disease (70%) were the most sought-after information. Those who spent more time than intended have significantly higher fear scores than those who did not (P = 0.025). The fear score did not differ significantly from other parameters of information-seeking behavior and its consequences. Conclusion: Pathological fear in older Indian adults is lesser when compared to other population groups, probably because of the maturity of response to the situation. Most of the information sought is on symptoms of disease, preventive measures, and guidelines and sought through passive sources rather than actively searching or in-person. Those with higher fear scores spent more time searching for information than intended but did not perceive any dysfunction due to said behavior.
| A Study of Codependence and Resilience in Primary Caregivers of Patients with Alcohol Dependence Syndrome | | |
B K Gracy, Nitin Raut, Dinesh Kataria
Lady Hardinge Medical College, Delhi, India
E-mail: [email protected]
Abstract
Background: Codependence includes mental, emotional, and behavioral difficulties experienced by the spouses and children of alcohol dependence patients which contributes to the drinking problem whereas resilience is the capacity to persist, fight back, and even succeed under stressful circumstances. It helps families in dealing with significant interpersonal, marital, social, and professional dysfunction. There is dearth of literature looking into the factors affecting these two variables and their association with each other. Objectives: To study the proportion of codependence and level of resilience and the relationship between the two variables in primary caregivers of patients with alcohol dependence syndrome. Methods: It was a cross-sectional study conducted at the department of psychiatry and drug de-addiction center in a tertiary care teaching institute on 120 primary caregivers of male patients with alcohol dependence. After institutional ethics clearance, the primary caregivers were assessed using a semi-structured pro forma, Codependence Assessment Questionnaire (for codependence), and CD-RISC-25 (for resilience). Appropriate descriptive and analytical statistical methods were used to analyze the data. Results: The study demonstrated that 85% of the caregivers reported codependence. Moreover, the level resilience in primary caregiver indicated by mean (standard deviation [SD]) of CD-RISC-25 was 58.06 (9.94). The level of resilience was significantly higher in codependence absent group than present group (mean and SD: 72.7 (11.54) and 55.5 (9.55), respectively, and P < 0.001). Conclusion: Significant proportion of primary caregivers of alcohol dependence patients exhibited codependence and those with codependence present exhibited lower level of resilience than those without codependence.
| Exploratory study of subjective sleep, polysomnographic characteristics, and quality of life among various psychiatric patients | | |
Suresh Parihar, Premprakash, Shri Gopal Goyal, K K Verma
MindCare Clinic, Suratgarh, Rajasthan, India
E-mail: [email protected]
Abstract
Background: Psychiatric patients report disturbed sleep in the context of sleep duration, sleep latency, sleep maintenance, and quality of sleep. Sleep disturbances may be cause, symptoms, or associated condition with psychiatric disorder that may significantly impairs quality of life. Polysomnographic evaluation is gold standard for sleep problems. Objectives: To study subjective sleep, polysomnographic characteristics, and quality of life among various psychiatric patients. Methods: This was a cross-sectional study conducted at tertiary care hospital. Patients with sleep complaint were enrolled. Mini-International Neuropsychiatric Interview 6.0.0 was used to diagnose psychiatric disorder. Pittsburgh Sleep Quality Index (PSQI) for subjective sleep, WHOQOL-BREF for quality of life, and polysomnography for objective assessment of sleep were used. Results: Majority of the patients reported poor sleep quality even though they had ≥6 h of sleep. Majority (57%) of patients reported 85% of habitual sleep efficiency. Total quality of life (QOL) was correlated significantly with all the four domains of WHOQOL-BREF. Arousal index was 13.40 ± 12.51. Snoring index during NREM sleep was 183.11 followed by REM (166.55). Gender was positively correlated with REM latency whereas negatively correlated variables were age versus SPO2, education versus family, total PSQI versus sleep quality index, and sleep quality index versus REM duration. Conclusions: Patients reported disturbed sleep, however, on polysomnographic assessment, average sleep efficiency with increased REM latency was found. Total QOL was significantly correlated with its all domains.
| A Study Comparing the Brain Metabolites in Left Dorsolateral Prefrontal Cortex using Proton Magnetic Resonance Spectroscopy among Migraineurs with and without Major Depressive Disorder | | |
Bhavika Rai
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Migraine is commonly comorbid with major depressive disorder (MDD). The pathophysiological inter-relationship between migraine and depression is less distinct. The dorsolateral prefrontal cortex (DLPFC) has been commonly implicated as an area of interest among patients having migraine and comorbid depression. The findings to date are inconsistent in the available literature while they tried to quantify various brain metabolites in DLPFC among patients with migraine and comorbid depression. In addition, direct comparative studies between migraine population with and without comorbid depression are scanty. The current study was thus undertaken to measure and compare the levels of various brain metabolites among the patients of migraine with and without depression using proton magnetic resonance spectroscopy (MRS). Methods: Migraine patients were recruited from a tertiary care center. After assigning a clinical diagnosis, the patients were assessed on Mini-International Neuropsychiatric Interview 5.0.0 for comorbid psychiatric illness. The patients having a comorbid psychiatric condition other than MDD were excluded from the study. The study subjects were divided into two groups according to the presence or absence of depression. Thirty subjects in the group of migraine patients with depression (Group A) and 27 subjects in migraine patients without depression (Group B) were included. All patients underwent a MRS examination focusing on bilateral DLPFC. The ratios of N-acetyl aspartate (NAA), choline (Cho), and myo-inositol (mI) to total creatine (tCr) were compared between migraine patients with and without MDD. Results: Significant difference was not noted in the NAA/tCr, Cho/tCr, and mI/tCr ratios of either of the two groups. Conclusions: The absence of any significant difference in the metabolite ratios among the two groups might be due a number of plausible reasons. Additional studies of metabolite ratios could add to the understanding of metabolite dysfunction and thus pathophysiology of migraine comorbid with MDD.
| Role of “Perceived Social Support” and “Mental Adjustment to Cancer” in Depression among Patients with Breast Cancer in the Indian Setting | | |
Tushar Panda, Mukesh Kumar Swami, Navratan Suthar, Jeewan Ram Vishnoi, Puneet Pareek, Kuldeep Singh
AIIMS, Jodhpur, Rajasthan, India
E-mail: [email protected]
Abstract
Background: The burden of psychological comorbidity such as depression and anxiety in patients with breast cancer is very high. Perceived social support (PSS) is an important protective factor against depression in such patients. Objectives: This study aimed to find the relationship of PSS and mental adjustment to cancer with depression in patients with breast cancer. Methods: The study sample consisted of adult patients with breast cancer (n = 76) undergoing treatment at a tertiary care hospital. Sociodemographic and clinical data were collected. The Patient Health Questionnaire-9 was used for screening depression, and the diagnosis of depression was confirmed subsequently as per the Diagnostic Criteria for Research of International Classification of Diseases, 10th edition. The Hamilton Depression Rating Scale was applied to diagnosed cases of depression for assessing the severity of depression. PSS and coping style were assessed with the Multidimensional Scale for Perceived Social Support and Mini-Mental Adjustment to Cancer (Mini-MAC) scale. Descriptive analysis, Fisher's exact test, Mann–Whitney U-test, Spearman's rank-order correlation, and mediation analysis were performed to analyze the data. Results: Nearly one-fourth of the participants had depression. PSS showed a positive correlation with adaptive subscales of Mini-MAC (fighting spirit, cognitive avoidance, and fatalism) and negative correlation with maladaptive subscales (hopelessness–helplessness and anxious preoccupation). Mediation analysis shows that hopelessness–helplessness mediates the effects of PSS on depression. Conclusion: Fostering healthy social support can potentially reduce the chances of depression mediated through a reduction in maladaptive coping (hopelessness–helplessness).
| Atypical presentation of Pediatric Acute-Onset Neuropsychiatric Syndrome: A Case Report | | |
Tathagata Biswas, Shree Mishra, Ankit Kumar Sinha, Susanta Kumar Padhy
AIIMS, Bhubaneswar, Odisha, India
E-mail: [email protected]
Abstract
Background: Pediatric acute-onset neuropsychiatric syndrome (PANS) is an abrupt onset disorder characterized by obsessive–compulsive disorder (OCD) or anorexia with concomitant at least two of the seven identified neuropsychiatric symptoms. Objective: To understand the complex presentation of overlapping restrictive eating behavior and affective, psychomotor, and behavioral alternations following a febrile illness in a young female child. Methods: A pediatric girl visiting the outpatient department of tertiary care center was evaluated in detail and managed. Furthermore, relevant literature search was done. Results: The restrictive eating behavior and body image concern were amplified in a young girl after a febrile infection along with severe psychomotor retardation and new-onset obsessive–compulsive symptoms. A diagnosis of atypical PANS was considered. She was treated with tablet fluoxetine 20 mg/day with considerable improvements in her symptoms by 1½ months. Conclusions: Various diagnostic categories and overlaps were identified. PANS and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections are specific OCD phenotypes that include acute-onset OCD symptoms, restricted eating, or tics comorbid with multiple psychiatric and neurological symptoms. The causal mechanism is probably multiple triggers initiating a neuroimmune process converging on a common pathway leading to the clinical presentation. Research is underway regarding potential treatments but is currently limited. Empirical studies and case reports suggest that potential PANS treatments should consist mostly of therapies that target immune and infectious causes. Further studies to see the long-term course of restrictive feeding with comorbid medical and psychiatric illnesses in young children are needed.
| A Study of Personality Factors, Coping Styles, and Perceived Stress in Parents of Children with Intellectual Disability | | |
Neha Mattikoppa
Vardhman Manahvir Medical College and Safdarjung Hospital, Delhi, India
E-mail: [email protected]
Abstract
Background and Objectives: Children with Intellectual disability (ID) are chronic stressors to families. Studies found association between severity of ID with stress whereas others between disturbed behavior with increased stress. Research suggests that parents using emotion-based coping are more vulnerable to depression, anxiety, and stress compared to using problem-based coping mechanisms. Studies show impact of personality factors on perceived stress and coping used. Methodology: This was a cross-sectional study in the department of psychiatry of tertiary care hospital in Delhi on 30 parents of children with ID. Ethical clearance from IEC and informed consent from patients were taken. Sociodemographic details were recorded using semi-structured pro forma, FISC-MR used to assess stress and coping, and 16-PF to assess personality characteristics of participants. Results: Among our participants, 63.33% were mothers and 36.67% were fathers with mean age 39.37 ± 6.2. The mean social quotient (SQ) of children was 52.6 ± 14.29. Forty percent of parents reported definite decrease in leisure time and 66.67% of people reported definite personal distress. Eighty percent of parents reported either favorable toward their child and 60% of families were well adapted. SQ of child was significantly associated with various factors of perceived stress and socioeconomic status was significantly associated with various factors of coping strategies and mediators. Factors C, H, I, Q3 and factors F, G, L, Q2, Q4 were found to be associated with perceived stress and mediators or respectively. Conclusion: Parents having children with ID experience significant stress and use different mediators. The current study showed association of SQ with stress and association of personality factors with both stress and coping strategies.
| Profile of Homeless Attended at Psychiatry Department of a Tertiary Care Center during Lockdown | | |
Shivani Deshwal, Shipra Singh, Aparna Goyal, Bhupendra Singh, Rajiv Gupta
PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Objective: Homelessness and mental illness have an intricate relationship. Homeless mentally ill is a vulnerable group and this vulnerability amplified during time of the pandemic, especially during the lockdown phase. To study the demographic and clinical profile and outcome details of the homeless attended in psychiatry department during lockdown. Methods: This is a retrospective study conducted in the psychiatry department of a tertiary care teaching hospital. The records of all the homeless who attended or were brought by or referred were included in the study. Patient's demographic, clinical, and rehabilitation details were collected during the surge of COVID-19 cases in India during lockdown using a semi-structured pro forma. The analysis was done using descriptive method. Results: There were a total of 23 homeless persons referred during the first phase of lockdown. The average age was 37.5 years; 22 were male and 1 female. Most referrals were because of wandering and disorganized behavior increasing the risk of COVID transmission. Majority of them had the diagnosis of unspecified nonorganic psychosis. Rehabilitation of almost half of them to nongovernmental organizations could be done by the management team. Conclusion: Recent pandemic has augmented the problems of homeless mentally ill, an important reason being lack of well-defined guidelines about this group. There is a need for making new laws addressing the issues of homeless and further research on the issue of homelessness and mental illness.
| Award Oral Communications | | |
| Mental Health Task Shifting for Accredited Social Health Activists: Results from a Randomized Controlled Trial | | |
P Lakshmi Nirisha, Barikar C Malathesh, Nitesh Kulal, Nisha R Harshitha, N Manjunatha, C Naveen Kumar, Rajani Parthasarathy, A M Adarsha, Suresh Bada Math
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness in India. Easily available and accessible digital technology can be utilized to continuously engage grassroot-level health workers (for example, accredited social health activists [ASHAs]). However, impact of such a strategy is not yet systematically evaluated. Methods: In this randomized controlled trial, the longitudinal hybrid training of ASHAs (1-day in-person classroom training in screening and referral of those with possible mental illness and 7 online sessions on commonly prevalent mental health issues in the community) was compared with traditional one time in-person classroom training. ASHA workers (n = 75) from 6 primary health centers from Ramanagara district, Karnataka, were randomized equally into study group (SG; n = 26) and control group (CG; n = 26). Pre–post scores on knowledge, attitude, and practices (KAP) and the number of people identified as screen positives (for possible mental illness) formed the outcome measures. Online sessions occurred over 18 months, predominantly due to COVID interruptions. Results: The mean total KAP score increased from 16.76–18.57 (P < 0.01) in SG-PHC ASHAs while it increased from 18.65–18.84 (P = 0.76) in CG-PHC ASHAs. Repeated measure ANOVA favored SG ASHAs for total KAP (P = 0.032, F = 4.887), knowledge (P = 0.04, F = 4.372), and practice scores (P < 0.00, F = 15.22). Furthermore, SG ASHAs identified significantly higher proportion of alcohol use disorders (P = 0.008) but not common mental disorders (P = 0.144) and severe mental disorders (P = 0.180). Conclusion: Hybrid longitudinal training method for ASHAs is better than one-time classroom training with regard to skill acquisition and positive screening of those with possible mental illness. Scaling up such initiatives carry potential to considerably improve treatment access for those in need.
| “Narratives of Being a Mother…” – Experiences and Perceptions Related to Motherhood in Women with Severe Mental Illness | | |
Debanjan Banerjee, Rashmi Arasappa, Prabha S Chandra, Geetha Desai
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Most women with severe mental illness (SMI) are mothers, however, little is known about their own experiences and unique challenges in navigating motherhood. A qualitative study design with a social constructivist paradigm was used to explore lived experiences of mothers with SMI during the childbearing period. This paper focuses on the perceptions during the preconception and pregnancy period. Methods: The study used a qualitative design with social constructivist paradigm to obtain data from 30 mothers with SMI who had children less than 5 years of age. One-to-one in-depth semi-structured interviews were conducted with transcription, and inductive thematic analysis was used to explore transcripts using Charmaz's grounded theory. Triangulation and respondent validation were used to ensure rigor. Results: Emergent categories (themes) were thoughts/feelings about childbearing (ambivalence about being a mother/having a baby, fantasies about childbearing/rearing, and guilt about pregnancy), the impact of mental illness (stigma, effect of symptoms on their self-care including health care, and concerns about effect of medications on fetus), unmet needs (lack of emotional support, unanswered doubts about effects of illness on pregnancy, child and motherhood, and wanting to be considered “potential mothers”), and caregivers' reactions (discrimination, anger/abuse, and selective support). The centrality of motherhood and balancing the “dual role” of a patient and mother were the overarching categories after analysis. Conclusion: Mothers with SMI prize motherhood but navigate through it with various adverse experiences. Hearing their voices is essential for service provision and ensuring adequate mental health and handling motherhood. The results of this study, grounded in their voices, provide critical insights for service provision in perinatal psychiatry.
| Factors Associated with Poor Response to Clozapine in Schizophrenia: A study from Northern India | | |
Chandrima Naskar, Sandeep Grover, Subho Chakrabarti
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Clozapine is considered the antipsychotic of choice for patients with treatment-resistant schizophrenia (TRS). Despite its proven efficacy in TRS, around 40%–70% of patients have a poor response to clozapine. Limited numbers of studies have assessed the predictors of clozapine nonresponse. Objective: This study aims to assess the demographic and clinical factors associated with an inadequate response to clozapine in patients with TRS. Methods: Two hundred and eighty-seven outpatients with TRS receiving clozapine for more than 1 year were divided into two groups based on the need for a second antipsychotic medication and/or electroconvulsive therapy after receiving clozapine in the maximum tolerable dose for at least 3 months. Results: One-hundred and two (35.4%) of the patients were considered to have inadequate response to clozapine. Compared to responders, clozapine nonresponders were unemployed at the time of starting clozapine (P = 0.04), had a higher duration of untreated psychosis (P = 0.007), had received significantly higher number of adequate trials in the past (P = 0.02), were treated with polypharmacy in the past (P = 0.01), had experienced adverse effects of first- (P < 0.001) and second-generation antipsychotics (P = 0.01), and had more medical comorbidities (P = 0.03). The nonresponders more frequently had visual hallucinations (P = 0.001), and made act (P = 0.04) in the lifetime, and had a significantly higher Clinical Global Impression score at the time of starting of clozapine (P < 0.001). While on clozapine, nonresponders received significantly higher dose of clozapine (P = 0.001) and experienced more constipation (P = 0.04), hypersalivation (P = 0.002), and obsessive–compulsive symptoms (P = 0.05). Conclusions: The present study shows that about one-third of the patients with TRS do not respond to clozapine. However, clozapine nonresponders, though broadly similar in sociodemographic profile, differ on past treatment profile.
| Poster | | |
| Challenges in Psychosocial Rehabilitation in an Unattended Patient with Organic Psychosis: A Case Report | | |
Rajvardhan Singh Bhanwar, Romil Saini, H Abdul Faheem, Ankit Gupta, Koushik Sinha Deb, Rakesh Kumar Chadda
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]
Abstract
Background: Psychosocial rehabilitation aims to provide opportunities for persons with mental illness to reach their optimal level of independent functioning in society and improving their quality of life. However, factors such as acute exacerbation of mental illness and lack of familial support have been described as among major barriers to psychosocial rehabilitation. Here, we present a case of an unattended patient with severe mental illness and associated challenges in psychosocial rehabilitation. Case Description: A 23-year-old unattended male was brought to hospital emergency department by local police with history of lying in an unconscious state on roadside. Examination showed that vitals were within normal range and orientation to time, place, and person. All routine investigations came within normal limits except urine drug screen which came positive for cannabis. The current illness duration was reportedly for 1 month, sudden in onset with episodes of throbbing frontal headache with nausea, vomiting, and blurring of vision with past history of seizure disorder for 10 years and under irregular treatment (phenytoin 300 mg HS). Psychiatry consultation was sought for alleged history of consumption of excess of phenytoin tablets. Associated history included recovery from COVID-19 1 month back. Inpatient care was planned due to repeated episodes of unconsciousness preceded by visual hallucination lasting for 15–30 min with postictal confusion. Mental status examination revealed delusion of grandiosity, confabulation about own residential address and deaths of close relatives due to COVID-19 in local hospitals, deficits in recent memory, impaired judgment, and insight of 3/5. Contrast computed tomography brain revealed right anterior temporal lobe cyst (2 × 1.4 cm) with no midline shift. Provisional diagnosis of organic psychosis was made and tablet olanzapine was started and raised up to 20 mg which showed improvement in delusion of grandiosity and visual hallucinations. Repeated attempts to find family details and address with help of medical social service officer and local police were unsuccessful. A series of lorazepam-assisted interviews hinted about name of family members and village in Midnapore, West Bengal. Local police at Midnapore could trace the family members, who reported the patient had left house 5 years back and expressed inability to come to Delhi to take the patient along with them due to financial constraints. Hospital social services provided financial help and arranged travel expenses (including railway ticket), so that the patient could reach his hometown in West Bengal. With the help of local police, the patient reached his hometown. Family members were psychoeducated about the patient's illness and need to continue treatment. In 6-month follow-up period, the patient is currently staying with his family and works as helper at a local “dhaaba” with continued treatment. Discussion: This case highlights some of the challenges in psychosocial rehabilitation in patients with mental illness and role of family support in community integration and improved quality of life.
| Delusion of Pregnancy in a Case of Gynecological Malignancy with Traumatic Childbirth: A Psychodynamic Conceptualization | | |
Nabagata Das, Shree Mishra, Susanta Kumar Padhy
All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
E-mail: [email protected]
Abstract
Background: Delusion of pregnancy is one of the rarer psychotic symptoms and can be found in patients with multiple disorders ranging from schizophrenia, schizoaffective, bipolar disorder, dementia, to other organic brain syndromes. As a symptom, it has to be differentiated from pseudocyesis, couvade syndrome, and simulated pregnancy. The symptom is explained by multiple etiological factors. We report here the case of a woman with past experience of traumatic childbirth who developed delusion of pregnancy on being diagnosed with a malignant pelvic tumor. Objectives: To understand a case of delusion of pregnancy with traumatic childbirth and recently diagnosed gynecological malignancy form a psychodynamic perspective. Case Presentation: Mrs. X, a 52-year-old widowed woman, premorbidly introverted, with past history of traumatic childbirth with obstructed labor 25 years back, personal history of regular menstrual cycles presented with a month long history of pain abdomen, pelvic fullness, diagnosed to have POD tumor, possibly malignant, followed by acute onset, deteriorating course of initially low mood, anhedonia, social withdrawal, disturbed biological function, later firm, fixed belief of being pregnant, and feeling of quickening. Mental status examination was corroborative with thought content revealing a well-systematized delusion of pregnancy with secondary extensions and possibly coenesthesia, depressed affect, absent insight, and impaired judgment. Conclusion: The relationship between trauma and psychosis is well known. Traumatic childbirth resulting in posttraumatic stress disorder has been reported in literature, whereas patients with posttraumatic stress disorder are also known to present with psychotic symptoms. In our patient, with a history traumatic childbirth, the past experience of helplessness and distress was triggered by a diagnosis of a pelvic tumor and the subsequent ordeal of medical investigations resulting in a psychotic breakdown with delusion of pregnancy as the predominant symptom.
| Kleine–Levin Syndrome – A Case Report | | |
Mondeep Dhankar, Mini Sharma
Institute of Human Behaviour and Allied Sciences, Delhi, India
E-mail: [email protected]
Abstract
Background: Kleine–Kevin syndrome (KLS) is a rare disorder characterized by excessive sleeping, hyperphagia, hypersexuality, and hallucinatory behavior. It can last for few weeks to months with complete interepisodic recovery. Case Report: A 34-year-old male was brought to a tertiary care psychiatry hospital with complaints for 15 days of excessive sleepiness for approximately 12–14 h in a day for the past 2 weeks. He would get up intermittently and would eat voraciously and sleep again. This was also associated with hypersexual behavior and blurting out profanities. There was history of self-stimulation of sexual organs when he was not sleeping. There were a few episodes of irrelevant talking and he would tell his family that he had reached a different world. On further probing, there was history of similar episode of illness, 2 years back which had settled spontaneously after a couple of weeks. There was history of mild viral fever with cough and coryza, before both the episodes. He had been treated by various physicians elsewhere and had been started on a cocktail of antipsychotics and modafinil. Routine blood investigations and other tests including electroencephalogram, whole-night sleep study, and magnetic resonance imaging brain with contrast were normal. The patient was admitted and observed for 2 weeks, and his symptoms started gradually decreasing. A diagnosis of postviral fever and recurrent KLS was made. Conclusion: KLS is a rare and poorly understood neuropsychiatric disorder. KLS can be primary (idiopathic), or secondary (after an antecedent illness), as was in our patient. Establishing a diagnosis is important, as most of these patients do not require antipsychotic treatment and usually settle spontaneously.
| Managing Substance Use in an Adolescent Female with Sexual Abuse: A Case Report | | |
Sonam Mehuriya, Kajal Taneja, Sunila Rathee, Sidharth Arya, Rajiv Gupta
PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: Adolescence is a critical period of development with robust behavioral, morphological, hormonal, and neurochemical changes including changes in brain regions implicated in the reinforcing effects of drugs such as opioids. Females may have enhanced vulnerability due to fast onset of antinociceptive tolerance and reduced severity of somatic withdrawal symptoms during adolescence. Two-thirds of all women entering addiction treatment report a history of sexual or physical abuse. Objective: To discuss the management of substance use in an adolescent female with sexual abuse. Case Discussion: A 17-year-old female presented with the complaints of opioid use in the form of smack in dependence pattern since the last 8 months, usual dose being 0.5 g per day by chasing method, with withdrawal symptoms such as body ache, lacrimation, and diarrhea. There was a history of sexual abuse by her friend with history of giving sexual favors to her friend for financial help and substance use along with history of physical abuse by her father and brother. She was an easy-going child in premorbid temperament. Mental status examination revealed ideas of guilt. Based on history and mental status examination, the patient was diagnosed as a case of opioid dependence syndrome. Buprenorphine detoxification was done. As per POCSO Act, reporting was done to the nearby police station and both pharmacological and nonpharmacological intervention was done to manage the patient. Conclusion: Opioid use in an adolescent female with history of physical and sexual abuse posed challenges in the intervention of the patient and it further highlights the need of research in this area.
| Effectiveness of Venlafaxine in a Patient of Hoarding Disorder with Comorbid Depression: A Case Report | | |
Archish Khivsara, Mukesh Kumar Swami
Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
E-mail: [email protected]
Abstract
Background: Hoarding is defined as acquisition of and inability to discard items even though they appear (to others) to have no value. The bulk of evidence indicates that hoarding is a separate clinical syndrome, quite distinct from obsessive–compulsive disorder (OCD). Objectives: To explore the response of venlafaxine (serotonin-norepinephrine reuptake inhibitor [SNRI]) in hoarding disorder with comorbid depression. Methods: A 45-year-old married female, who had bilateral cataract, with premorbid well-adjusted personality, presented with low mood and collecting trash/unwanted things and hoarding them for the last 13 years with worsening in the last 4 years. The patient would get irritable when confronted or asked to clean her house. The patient would ask for unused items from neighbors but was not able to give any explanation. She was also noticed to hoard newspapers and food items. There is history of IPR issues with in-laws since her marriage 13 years back. In the last 4 years, the patient stayed with her mother for 3 years and has been staying alone for the last 1 year secondary to her hoarding behavior. The patient was diagnosed with depression and treated 2 years back (details not known) with no improvement reported. Results: No psychotic symptoms or anxiety symptoms were reported. The patient was started on venlafaxine which was optimized to a dose of 75 mg. The patient initially reported 40%–50% relief in symptoms with gradual improvement in biological and sociooccupational functioning with significant improvement in hoarding symptoms subsequently. Conclusions: We report a case of hoarding disorder with comorbid depression where response was seen to a SNRI. Prior studies have prospectively measured response to pharmacotherapy in compulsive hoarders in OCD patients but have not in hoarders with depression. No major studies have done to explore the role of medications other than selective serotonin reuptake inhibitors. Our results suggest that venlafaxine may be effective in a case of hoarding disorder with comorbid depression.
| Eagle's Syndrome with a “Fish Bone:” An Unusual Case of “Folie A Deux” | | |
Devendra Singh Basera
All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Background: Eagle's syndrome is a rare condition characterized by an elongation of the styloid process or calcification of the stylohyoid ligament. While this condition can present with unusual sensations in the throat and neck region, an unusual though the content of the patient shared by the caregiver with equal conviction is rare. Objective: To differentiate the abnormal pathology of bone and psychopathology of a fish bone presented as shared psychosis. Methods: A 30-year-old laborer from a rural background was attended by a consultation–liaison psychiatrist for persistent false belief for 2 years that a “fish bone” is stuck on the left side of his throat with multiple consultations sought from medical specialties. The symptoms of the pain and foreign body sensation in the throat were attributed to the radiological findings of elongated styloid process (3.9 cm on left and 3.7 cm on right) with ENT specialist from neurosurgery advising no surgical management. However, the patient and his mother consistently believed that the fish bone is stuck in the throat and persisted with a request for surgery on each consultation. In addition, voluntary neck muscle contractions by the patient on each examination setting were investigated as functional in origin. Further history was suggestive of interpersonal relationship conflict with the wife resulting in separation from the wife and pathological companionship with the mother. Diagnosis of persistent delusional disorder and shared psychotic disorder with Eagle's syndrome was considered. His Brown Assessment of Beliefs Scale score was 23/24. He was started on tablet olanzapine 10 mg while educating the mother for transient separation. Discussion: This is probably the first case report describing delusional disorder in the same site medical condition and a shared psychosis. An inclusive approach and effective liaison are required for the management of such presentations.
| Assessment of Gender Differences in Stress at Workplace and Psychiatric Morbidity among Staff Nurses | | |
Shabnam Sayeed
Amar Jyoti Rehabilitation and Research Centre (Study Centre), New Delhi, India
E-mail: [email protected]
Abstract
Introduction: The term stress has been commonly applied these days; the number of people who define themselves as stressed, or who consider others in varied situations as stressed, increases day after day. Stress has been the growing concern among health-care professionals, especially nurses. Objectives: The main objectives of the study were to assess workplace stress in staff nurses, to assess the prevalence of psychiatric morbidity among staff nurses, and to identify the difference in workplace stress level and psychiatric morbidity among male and female staff nurses. Methods: A cross-sectional study design was adopted on 50 female and 50 male staff nurses of Dr. Ram Manohar Lohia Hospital, New Delhi, selected through convenience sampling technique. A structured questionnaire to assess level of workplace stress among staff nurses and gender difference in stress at workplace and structured questionnaire to assess psychiatric morbidity were used. Data gathered were analyzed and interpreted using descriptive and inferential statistics. Results: Majority of staff nurses had moderate level of stress that is 62% of female and 62% of male staff nurses had moderate level of workplace stress. Twenty-four percent of female staff nurses and 20% of male staff nurses had severe level of workplace stress. There is no gender difference in workplace stress. None of the female staff nurses and none of the male staff nurses reported any psychiatric morbidity. Conclusion: The study concluded that both male and female staff nurses face moderate level of stress. None of the staff nurses reported worse mental health. Further research must be undertaken to investigate stress management techniques to surpass their workplace stress.
| Digital Initiatives in Realization of Mental Health care for All in Chhattisgarh State of India: A Bird's Eye View | | |
Praveen Pandey, Gopi V Gajera, Barikar C Malathesh, Hari Hara Suchandra, Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math, Sumi Jain
NIMHANS, Bengluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Lack of skilled mental health resources remains a major challenge in bridging the wide mental health treatment gap. Chhattisgarh Government and NIMHANS have extensively partnered using telementoring methods to impart essential mental health training to various cadres of primary health care. Objectives: To present a bird's eye view of NIMHANS-led technological initiatives in collaboration with Chhattisgarh in realizing the vision of mental health care at doorstep. Methods: Telementoring projects used in training for mental health screening, identification, treatment, and referral were reviewed. Plan for intersectoral coordination and a strong referral chain was drawn. Results: Chhattisgarh Community Mental Health Telementoring Project (CHAMP), Telementoring for Rural Health Organisers of Chhattisgarh (TORENT), and Virtual Knowledge Network (NIMHANS-VKN-ECHO) projects are actively involved in training nonspecialist health professionals at various levels, covering the entire state of Chhattisgarh. They include districts, blocks, community health centers, primary health centers, and health and wellness centers. Trainees include MBBS medical officers, district, rural medical assistants, community health officers (CHOs), and rural health organizers (RHOs). The CHAMP initiative engaged 1508 primary care doctors posted at PHC/CHCs, of which 314 were certified and benefitted more than 32,500 patients over the past 2 years. The TORENT project started in 2021 and has trained more than 400 CHOs and 200 RHOs facilitating nearly 120 patients' referrals over 6 months. The NIMHANS-VKN-ECHO project trained 34 medical officers and 69 counselors over the past 3 years, and virtual-ECHO-clinics at district hospitals reached about two lakh patients in the last 3 years. Conclusions: Technology has helped mental health-care delivery in community even in the trying times of COVID-19 pandemic. Telementoring initiatives carry immense potential in task shifting and bridging the mental health-care delivery in the community. We plan to incorporate training for special populations and disability and rehabilitation services in future.
| Prevalence of Sexual Dysfunction in Patients Suffering from Affective Disorder | | |
Gopika Jagota, Aseem Mehra, Swapnajeet Sahoo
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Aim: To assess the prevalence of sexual dysfunction in patients suffering from affective disorder. Methodology: One hundred and thirty-four patients suffering from affective disorders (74 patients suffering from bipolar disorder and 60 patients suffering from depressive disorder) currently in clinical remission were assessed on the Arizona Sexual Experience Scale. Results: The mean age of the study sample was 48.3 years (standard deviation [SD]: 13.9), with mean age of patients with bipolar disorder being 44.1 (SD: 13.2) years and those with depressive disorder being 53.5 (SD: 12.9) years. The mean duration of illness was 15 years (SD: 11.7) for the whole group with mean duration of illness for bipolar disorder being 16.2 years (SD: 10.3) and for depressive disorder being 13.6 years (SD: 13.1). In the whole sample, the prevalence of sexual dysfunction was 36.6%. The prevalence of sexual dysfunction in bipolar disorder group was 32.4%, and in the depressive disorder group, the prevalence was 41.7%. In terms of various domains of sexual dysfunction, when the cutoff of o4 was used, in the whole sample, the highest level of dysfunction was seen in the domain of desire (39.6%), followed by arousal (38.8%), penile erection/vaginal lubrication (29.1%), satisfaction with orgasm (26.9%), and least in the domain of ability to reach orgasm (22.4%). In all the domains, patients with depressive disorders had higher prevalence, when compared to patients with bipolar disorder. In the whole sample, sexual dysfunction was more prevalent among those who were older and female. Conclusions: Slightly more than one-third of the patients suffering from affective disorders experience sexual dysfunction. Hence, clinicians should routinely enquire about sexual dysfunction from patients with affective disorders.
| Does Opioid Substitution Therapy Improve the Social Functioning of Opioid-Dependent Individuals | | |
Sabaresh Pandiyan, Renjith R Pillai, Abhishek Ghosh, Debasish Basu
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Substance use disorder is a long difficult battle fought against oneself. Among them, opioids are known for their highly enslaving property. Opioid substitution therapy (OST) has been proved to be an effective treatment for opioid dependence, but the long-term functioning of the individual and its impact on one's family requires further evaluation. Objectives: To assess the change in social functioning and family burden in patients on OST. Methods: A prospective observational study in which patients recently started on OST was followed up for 6 months. Using Social Adjustment Scale and Family Burden Interview Schedule assessment was done from the patient and their respective caregivers. Results: Initially, 45 patients were recruited, out of which 22 patients dropped out by 6 months giving a total dropout rate of 48%. In the treatment completers, there were significant differences in the mean scores of overall social functioning from baseline to 6 months (P < 0.001). Regarding family burden, in the treatment completers, the mean scores of all domains showed a significant difference (P < 0.05) at 6 months compared to baseline. Conclusion: OST not only helps an individual by improving his functioning but also helps a family as a whole.
| Prevalence and Correlates of Metabolic Syndrome in Patients with Depression Admitted to Psychiatry Inpatient Unit | | |
Rahul Chakarvarty, Sandeep Grover, Subho Chakrabarti, Aseem Mehra, Swapnajeet Sahoo, B N Subodh
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Aim: To assess the prevalence and correlates of metabolic syndrome in patients with depression admitted to psychiatry inpatient unit. Methodology: By using retrospective study design, the treatment record data of 476 admitted patients diagnosed with depressive disorders (first episode or recurrent depressive disorder) as per the International Classification of Diseases-10 were reviewed and data for metabolic syndrome were extracted. Results: Slightly less than half (45.8%) of the patients fulfilled the criteria for metabolic syndrome. The mean age of the study participants was 46.22 (standard deviation [SD]: 16.87) years and the mean number of years of education was 11.19 (SD: 4.70) years. The mean duration of illness was 110.47 (SD: 107.93) months and the mean duration of current episode at the time of collection of data was 10.44 (SD: 9.76) months. A higher proportion of those with metabolic syndrome were older in age, were more educated, were of female gender, had longer duration of illness, were more often diagnosed with recurrent depressive disorder, and had presence of physical comorbidities. Conclusions: The high prevalence of metabolic syndrome in patients with depressive disorders suggests that there is a need to closely monitor the patients with depressive disorders for metabolic syndrome.
| Does Telepsychiatry Offer Any Advantage over In-Person Consultation in Reducing Treatment Dropout | | |
Sabaresh Pandiyan, Rahul Chakravarty, Manpreet Singh, Sandeep Grover, Subho Chakrabarti, Debasish Basu
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: In the wake of the COVID-19 pandemic, the Government of India notified guidelines for telemedicine practices and allowed telemedicine to be used for routine services. Over the last 1½ years, telemedicine has become very popular and had been utilized by a large number of patients across the country. However, little is known about the influence of teleconsultation on the treatment dropout. Objectives: To compare the treatment dropout rates among patients seeking in-person consultation with those seeking teleconsultation. Methods: Using a retrospective study design, data of 7584 patients aged 18 or above who sought first psychiatric consultation between July 1, 2019, and December 31, 2019, were compared with 1637 new patients aged 18 or above seeking teleconsultation from July 1, 2020, to December 31, 2020. Results: Only 25.7% of the patients who registered during the in-person consultation underwent detailed evaluation meaning visited at least once or more, whereas 43% of the patients who registered with the teleconsultation services underwent detailed evaluation and came back to the services at least once, and this difference was statistically significant, in favor of teleconsultations. Sixty-one percent of patients seeking in-person consultation and 44% of patients seeking teleconsultation did not return after the first consultation; the difference between this difference was not statistically significant (χ2 = 2.33 [P = 0.12]). Conclusions: Teleconsultation has no advantage in terms of reducing the number of patients not returning after the first consultation.
| Depression and Corpus Callosum Dysgenesis: A Case Report and Review of Literature | | |
Ashish Pakhre, Pankaj Mahal
All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Background: Corpus callosum is a white matter structure that is involved in the exchange of information between two cerebral hemispheres. Neuropsychiatric manifestations of dysgenesis of corpus callosum have been reported in scientific literature but not fully understood. Behavioral problems, depression, and psychosis have been linked to corpus callosum anomalies. These neuropsychiatric disturbances seen in anomalies of corpus callosum need to be explored in detail for better understanding of etiopathogenesis, impact, and management of these behavioral disturbances. Objectives: To describe and discuss the psychiatric symptoms presentation in corpus callosum dysgenesis and colpocephaly. Case Description: A 49-year-old male presented with headache and depressed mood, irritability, anhedonia, easy fatiguability, sleep disturbance, decreased appetite, forgetfulness, decreased libido, crying spells, ideas of hopelessness, and with occasional death wishes. Routine laboratory parameters were found to be within normal range. There was a positive family history of suicide in second-degree relative, but apart from that, there was no other chronic medical or psychiatric illness in the family. Further evaluation revealed, he had history of biparietal headache around 4 years back. Headache was moderate, without nausea and vomiting. Magnetic resonance imaging brain showed nonvisualization of body of corpus callosum with widely separated bilateral lateral ventricles with bodies of lateral ventricles lying parallel to each other with mildly prominent occipital horns, overall suggestive of corpus callosal dysgenesis with colpocephaly. Conclusions: Corpus callosum abnormalities are rare and patients have presented with neuropsychiatric symptoms as evident in literature review, but such reports are scarce. This case further supports the connection between corpus callosum dysgenesis and mood symptoms. Further studies of mental disorders in patients with such anomalies are necessary to enhance our understanding of origin of psychiatric symptoms.
| Study of Insomnia in Hospitalized COVID-19 Patients in a Tertiary Care Hospital of Central Gujarat | | |
Drashti Shah, Sandip Shah, Nimisha Desai, Saurabh Shah, Shreyasee Bhowmick
GMERS Medical College and Hospital, Ahmedabad, Gujrat, India
E-mail: [email protected]
Abstract
Background: Targeting underlying psychological issues and sleep disturbance in COVID-19 patients would contribute to overall recovery of patient, so this study tried to assess insomnia and psychological stress of these patients. Objectives: To study insomnia and psychological stress in COVID-19-positive patients who were hospitalized. Methods: A prospective longitudinal quantitative study was conducted over a period of 3 months during the first wave in all the patients admitted in general ward after taking permission from the Institutional Human Ethics committee. Two-stage cross-sectional assessment was done using a semi-structured interview via telephonic route, which consisted of oral consent, sociodemographic detail, details of Illness, any stressors, etc. For assessing insomnia, Insomnia Severity Index was used and Patient Health Questionnaire-4 was used for psychological stress on day 1 and day 10 of hospitalization. Appropriate statistical analysis was done. Results: Total 194 patients had completed assessments, the mean age was 55 years. Twenty-four percent of the patients had sleep disturbance on the day of admission which decreased to 9% on day 10 which was statistically significant (P < 0.001) and 8% showed psychological stress on the day of admission while 5% still continued to have psychological stress on day 10. The mean duration of hospitalization was 4.7 days. A moderate-to-weak correlation was found in between insomnia and psychological stress (r = 0.45). Patients <30 years had insomnia in both the assessments (37%–18%) and patients with any stressors had insomnia during both the assessments (44%–32%). Conclusion: The patients who were admitted in the general ward had insomnia and psychological stress during early phase of illness, and in majority of them, insomnia was self-remitting.
| Study of Medical Comorbidities in Adults with Depression and Anxiety Disorders | | |
Vibhor Jain, Dinesh Kataria, Sumit Rana, Swati Sharma
Lady Hardinge Medical College, New Delhi, India
E-mail: [email protected]
Abstract
Introduction: Depression has now become a common illness worldwide. It has become a major public health problem. It occurs in persons of all ages and is associated with increased risk of morbidity and reduced quality of life in all age groups. In the present scenario, it has become the second most common cause of disability in the world and is on course to become the leading cause of morbidity worldwide by 2030. Anxiety disorders are the most prevalent mental disorders and associated with immense health-care costs and a high burden of disease. According to surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Anxiety disorders follow a chronic course and are highly comorbid with other mental disorders and medical comorbidity. Many of the medical comorbidities such as hypertension and diabetes had shown to be associated with mental illness, especially depression and anxiety disorders. Objectives: To estimate the prevalence of medical comorbidity in adults with depression and anxiety disorders. Methods: Patients attending the Psychiatry Outpatient Department in Lady Hardinge Medical College diagnosed with depressive and anxiety disorders in the age group ≥40 years, fulfilling the inclusion criteria, and giving informed consent were assessed for any medical comorbidity. A semi-structured pro forma along with the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety was applied to assess the severity of depression and anxiety, respectively. The data were analyzed by using SSPS software. Results: It will be revealed at the time of presentation. Conclusions: Depression and anxiety disorders are more commonly associated with medical comorbidities, especially in adults which need intervention.
| Marital Satisfaction among Men with Alcohol Use Disorder | | |
Simran Doria, Shiv Prasad, Mini Sharma
Lady Hardinge Medical College, New Delhi, India
E-mail: [email protected]
Abstract
Background: Marital satisfaction is a mental state that reflects the perceived benefits and costs of marriage to a particular person. Alcohol dependence is associated with adverse consequences – physical, mental, and social. A lot of problems associated with alcohol use occur within the family and, most importantly, affecting the married life of the individuals. Therefore, we need to assess the marital satisfaction and its relationship with the severity of alcohol dependence so that we can understand and address this issue. Objectives: Primary objective: To assess the level of marital satisfaction in adult males with Alcohol Use disorder. Secondary objective: To assess the relationship of marital satisfaction with the severity of Alcohol Use Disorder. Methods: Thirty males with clinically diagnosed alcohol use disorder were assessed for marital satisfaction, which was measured using the Dyadic Adjustment Scale. The severity of alcohol dependence in the patients was assessed using the Addiction Severity Index. Results: Data analysis is yet in the preliminary stage. Marital dissatisfaction is present in men with alcohol use disorder. The final results after detailed analysis would be discussed during the presentation. Conclusions: The detailed conclusion after completion of data analysis would be discussed in the presentation. Marital satisfaction is an essential part of the well-being of an individual. Alcohol use disorder is known to cause disharmony with the spouses and sexual dysfunction. Marital dissatisfaction in these individuals is often a neglected issue, which is a major cause of distress to the patient as well as to their spouses, and it can be one of the reasons for relapse as well. Hence, it is imperative to address this issue in our clinical practice.
| Medical Certification in a Tertiary Psychiatric Hospital Using a Structured Tool | | |
A S Bhaskaran, Suresh Bada Math, C Naveen Kumar, N Manjunatha
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: Certification in psychiatry is a challenge to any psychiatrist. After implementation of Mental Healthcare Act 2017 and Rights of Persons with Disabilities 2016 Act, it became even more challenging. Hence, in this study, certification process was studied prospectively using a tool. Objective: To study the process of certification. Methods: A structured tool was drafted after literature review and it was reviewed and approved by the psychiatrists working in the field of forensic psychiatry. Tool includes enquiry phase, decision phase, documentation and drafting phase, and issuing phase. Any patient visiting hospital with the request for medical certificate was enrolled in the study after obtaining informed consent. Once the patient gave informed consent, sociodemographic details were collected and appropriateness of the request was assessed, and if it was appropriate, further details were collected and documented in the file. Following this, certificates were provided to the requester by the psychiatrist or the medical review board. Results: Thirteen patients were recruited in the span of 6 months. Among these, ten requests were in person and three requests were by post. Disability certificates (4) for the purpose of social security schemes and fitness to join the job (4) were the highest followed by request from court to assess and certify about the illness (1), certificate for money reimbursement from medical insurance (1), disability certificate for reservation in job (1), certificate for testamentary capacity, and treatment-related certificate for submitting in educational institute. Among these requests, four certificates were not issued as patients did not come for scheduled appointment. Apart from the disability certificate, others certificates did not have any prescribed format and certificates were worded by the issuing authority. Conclusion: This study showed that using a structured tool will help psychiatrists assess and provide certificates in a flawless manner.
| A Study of Depression, Anxiety, and Stress among Family Members of Hospitalized COVID-19 Patients in a Tertiary Care Hospital of Central Gujarat | | |
Malika Sanspara, Sandip Shah, Saurabh Shah, Nimisha Desai, Shreyasee Bhowmick
GMERS Hospital, Gotri, Vadodara, Gujarat, India
E-mail: [email protected]
Abstract
Introduction: Assessing the psychological impact on family members of the patients suffering from COVID-19 is also utmost important. Objectives: To assess the prevalence of depression, anxiety, and stress among family members of hospitalized COVID-19 patients and various factors related to it. Methods: A cross-sectional quantitative tertiary care hospital-based study was conducted after approval from Institutional Human Ethics Committee. Family members of hospitalized COVID-19 patients were assessed by purposive sampling method using semi-structured pro forma including sociodemographic details, illness related details, etc., via telephonic mode of interview. For assessing depression, anxiety, and stress, Depression, Anxiety, and Stress Scale-21 was applied. Analysis was done using appropriate statistical tools. Results: Total 200 family members were interviewed during the period of hospitalization. Majority were married educated males aged <45 years (mean age = 41.37 years) having first-degree relationship with the patient. Overall, 12% had depression, anxiety and stress and 25%, 21%, and 20% had depression, anxiety, and stress, respectively. Moreover, with further analysis, we found a higher prevalence of mild-to-moderate level of severity. Longer duration of hospitalization and female gender were significantly associated with all three parameters. Depression (χ2 = 8, P = 0.01) and stress (χ2 = 9.5, P < 0.01) were significantly associated with ICU hospitalization. Anxiety was significantly associated with low education of family members (χ2 = 6.11, P = 0.04) and spousal relationship with the patient (χ2 = 7.84, P = 0.01). Conclusions: Family members of hospitalized COVID patients also had depression, anxiety, and stress during hospitalization of their closed ones. Targeted intervention during their stay along with patients during hospitalization might help them to deal with distress.
| An Unusual Presentation of Tuberculous Meningitis | | |
Asha Davis, Sivin P Sam, Roy Abraham Kallivayalil
Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
E-mail: [email protected]
Abstract
Tuberculosis (TB) is caused by Mycobacterium tuberculosis infecting primarily the lungs but also affects other parts of the body. Tuberculous meningitis (TBM) is the most severe form of TB and has the highest mortality and morbidity rate compared to other forms of TB. Conversion symptoms can also coincide with organic neurological disease. Diagnosis of neurological conversion disorder is difficult as there is a considerable overlap in symptomatology of organic neurological disease. We report a 22-year-old male postgraduate with no previous history of psychiatric illness presented to the emergency department with complaints of headache, back pain, one episode of unresponsiveness, and transient weakness of left side of body which improved after 3 h. Convincing multiple psychosocial stressors were identified prior to the onset of symptoms. Neurological evaluation was unremarkable (normal magnetic resonance imaging). Mental status examination revealed dissociative symptoms and the patient got admitted to psychiatry ward. As the patient was not improving with pharmacotherapy and psychotherapy sessions, serial neurological evaluation was done and was found to be normal. CSF study cannot be performed in the initial period as bystanders were not willing for the same. Eight days after admission, the patient developed slowing of saccades, diplopia, visual hallucinations, and one episode of urinary incontinence, following which the patient was transferred to the neurology department and differential diagnosis of autoimmune encephalitis and viral or bacterial meningitis was made. CSF study showed lymphocytic pleocytosis, elevated protein levels, and a low glucose level. The patient was started on antitubercular treatment (ATT) and his condition improved. Early diagnosis is challenging due to the nonspecific symptoms of TBM. On time, diagnosis could dramatically affect the outcome.
| A Study to Determine the Effectiveness of Exposure-Response Prevention Therapy among the Obsessive–Compulsive Disorder Patients Visiting Outpatient Department at Government Psychiatric Disease Hospital (IMHANS-K), GMC, Srinagar, Kashmir | | |
Shabnam Ara
Government Nursing College, GMC, Srinagar, Jammu and Kashmir, India
E-mail: [email protected]
Abstract
The study was conducted with an aim to determine the effectiveness of exposure-response prevention therapy (ERPT) among the obsessive–compulsive disorder patients visiting the Outpatient Department (OPD) at Government Psychiatric Disease Hospital (IMHANS-K), GMC, Srinagar. This therapy will help to break an association between obsession and compulsion in order to develop self-control and in understanding the disease cycle to sustain their maintenance phase. Methodology: Quasi-experimental pre- and posttest control design was used to determine the effectiveness of ERPT among the OCD patients. Purposive sampling technique was used to collect data from OCD patients who fulfilled the inclusion criteria. Data were collected by using the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) checklist and scale and demographic socioeconomic status. The tool was validated by 12 experts. Reliability of the tool was established by using Karl Pearson's correlation coefficient (“r” = 0.98). Pilot study was conducted on seven patients who visited OPD at IMHANS-K, Srinagar. The main study was conducted on forty patients, among which only thirty have completed the intervention with a training of eight sessions twice weekly individual sessions of 60 min. Data collection and intervention schedule was started from March 10 to April 30 for thirty patients who were treatment completers of eight sessions of ERPT. Ethical clearance was obtained and the study was ethically accepted. Data were analyzed by using descriptive and inferential statistics to check the effectiveness of ERPT among the study subjects. Results: The findings of the study revealed that the intervention was effective and statistically significant with P < 0.001. Further demographic variables and clinical profile were nonsignificant to pretest score of Y-BOCS in control and experimental groups. Conclusion: The findings of the study concluded that intervention was effective and symptoms were reduced on posttest with P < 0.001. Furthermore, there was no significant association between pretest score of experimental and control groups of demographic variables and clinical profile of subjects. Implication: Determining the effectiveness of ERPT will reduce the OCD symptoms among OCD patients and decreases the burden of family members. Furthermore, psychiatric nurses can work as co-therapists and can use various counseling skills to enhance patient care.
| Personal Recovery and Its Correlates in Patients with First-Episode Psychosis | | |
Raj Laxmi, Swapnajeet Sahoo, Ritu Nehra, Sandeep Grover
E-mail: [email protected]
Abstract
Objective: To evaluate personal recovery and its correlates in patients with first-episode psychosis. Methodology: Fifty patients of first-episode psychosis currently in clinical remission for at least 6 months were evaluated on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale (PANSS), Negative Symptom Assessment Scale (NSA), and Calgary Depression Scale for Schizophrenia. The mean age of the study sample was 27.82 (standard deviation [SD]: 6.6) years, and more than half of the participants were male (62%). On RAS, the mean score was highest for domain of personal confidence and hope (mean: 3.75; SD: 0.35) followed by mean score for goal and success orientation domain (mean: 3.64; SD: 0.35), willingness to ask help domain (mean: 3.57; SD: 0.31), no domination of symptoms domain (mean: 3.29; SD: 0.42), and least for the domain of reliance on others (mean: 2.87; SD: 0.31). There was a significant correlation between all the domains of recovery, suggesting that personal recovery in one domain is associated with personal recovery in other domains. There was no significant correlation between any of the domains of recovery between age and education. None of the domains of recovery also had any significant association between residual psychopathology in measured PANSS except that the higher PANSS general psychopathology score was associated with lower recovery in domain 3 (goal and success orientation). Similarly, higher residual negative symptom as assessed by NSA was associated with lower recovery in domain 3 (goal and success orientation). There was no association with total duration of illness and duration of untreated psychosis. Lower age of onset is associated with lower rate of recovery in domain 2 (willingness to ask help) and domain 5 (no domination of symptoms). Conclusion: Personal recovery in persons with first-episode psychosis is not associated with demographic factor and residual positive and negative symptoms.
| A Case of Isoniazid-Induced Psychosis – Psychosocial Implications | | |
Supriya Suthar, Shefali Singla, Kajal Taneja, Hitesh Khurana
PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Isoniazid (INH) is used as a first-line agent in the treatment of TB. Besides reducing morbidity and mortality markedly, it sometimes causes troublesome side effects such as psychosis. In many situations, patients may even avoid INH due to stigma of mental symptoms. Here in the presentation, we illustrate the similar problem by demonstrating a patient of TB who developed psychosis following INH therapy. Objectives: To discuss the case of a 14-year-old girl who presented with INH-induced psychosis within 3 days of starting antitubercular treatment (ATT). Case Discussion: A 14-year-old girl diagnosed with pulmonary TB was started on ATT including INH in regime. She presented with restlessness and increased psychomotor activity, and hallucinatory behavior was observed. Based on mental status examination and ruling out other organic causes, she was diagnosed with INH-induced psychosis. Antipsychotics along with pyridoxine were added to the existing treatment. The patient recovered with treatment in a week time, and antipsychotics were tapered and stopped. On talking to the attendant, they reported marked apprehension due to the patient's psychotic symptoms. They were relieved on knowing that symptoms were not of primary psychosis and these were drug induced. Conclusion: The case depicts the fear and stigma among the people due to psychiatric symptoms. Despite increasing psychiatric treatment facilities in the country, the case clearly demonstrates the need to educate the people about psychiatric illness and treatment. Clinicians should pay attention to the clinical features after initiating INH treatment which will help in early diagnosis and immediate intervention to decrease suffering of the patient and family members.
| Human Rights Violation in a Psychotic Patient: A Case Report | | |
Shefali Singla
Pt BD Sharma PGIMS, Rohtak, Haryana, India
E-mail: shefalising[email protected]
Abstract
Background: Persons with mental illness often suffer from human rights violations, especially females with psychotic illness. As per Chapter V Section 20 of Mental Healthcare Act 2017, patients with mental illness should be given the right to protection from cruel, inhuman, and degrading treatment. This includes provision of a safe and hygienic environment. Objective: To discuss the violation of human rights in a psychotic patient. Case Discussion: A 35-year-old female of rural background was found in a locked washroom for 1 year. She was rescued by social welfare worker and presented with complaints of disinhibited behavior, poor self-care, self-smiling, and self-muttering. Premorbid personality was well adjusted. On GPE, there was fixed flexion deformity at bilateral knee with low BMI with poor oral hygiene. On systemic examination, there was decreased bulk in all four limbs with contractures in bilateral knee. On mental status examination, she was observed hallucinating making gestures and was noted self-absorbed. On the basis of history and examination, the patient was diagnosed as case of psychosis not otherwise specified with malnutrition. Along with pharmacological treatment, physiotherapy and psychosocial management was done. Conclusion: Forced seclusion and restricting freedom and autonomy in a person with severe mental illness violate human rights of such patients and such persons deserve proper dignified care in a hygienic environment from their families and society. There is a need of social welfare organizations to provide employment opportunities, disability allowance, housing, and other social security's for women with mental illness. Further, mental health professionals should help in creating awareness in public regarding human rights of people with mental illness.
| Catatonia as a Rare Presentation in Alcohol Withdrawal State | | |
Rini Maurya, H S Dhanashree Akshatha, M T Sathyanarayana
Sri Siddhartha Medical College, Tumkur, Karnataka, India
E-mail: [email protected]
Abstract
Introduction: Catatonia is a clinical syndrome closely associated with motor dysregulation, affect, thought, and cognition. The classical signs of catatonia include mutism, rigidity, posturing, waxy flexibility, automatism, negativism, and stupor/excitement. Catatonia is recognized in numerous psychiatric and medical illnesses including neurological and metabolic disorders. Epileptic seizures and/or delirium tremens are considered to be the complication of alcohol withdrawal syndrome (AWS). However, there has been lack in literature for catatonia as a consequence of AWS, especially in terms of clinical reports. Only a few cases have been reported in literature till now. Hence, we present a young male with no significant past or family history of any psychiatric or major medical illness. Case Report: Mr. D, a 32-year-old unmarried male from a rural background in South India and working in a garment factory, presented with a history of alcohol consumption for 13 years, leading us to a diagnosis of alcohol dependence syndrome as per the International Classification of Diseases, 10th revision (ICD-10). In the absence of alcohol for 3 days due to COVID-19 lockdown, he developed withdrawal symptoms and next day developed severe abnormal behavior and was brought to us with staring look, mutism, posturing, and rigidity fulfilling the ICD-10 criteria of catatonia with no mood symptoms, seizures, head injury, clouding of consciousness, disorientation, or any general medical condition that could explain these symptoms. Bush-Francis Catatonia Rating Scale came out to be 23. Following inpatient care with injection lorazepam 4 mg iv slow stat, followed by tablet lorazepam 2 mg QID, his abnormal behavior was found to be improved much within few hours.
| An Alternative Narrative amid the Pandemic – An Integrated Community Approach in Care Delivery during Perinatal Period | | |
S Anitha, Poornima Sunder, Meenu K Saju, M Arun, Anupama V Prabhu, Anita Rajah, Chitra Venkateswaran, Roshni Robins
MEHAC Foundation, Kochi, Kerala, India
E-mail: [email protected]
Abstract
The pandemic and its mitigating effects have resulted in physical and social isolation which has created a negative impact on the mental health of vulnerable populations, especially with preexisting mental illness. Limited access to the health-care system and elevated risk of developing mental health problems has made pregnant and postpartum women more vulnerable during the pandemic. MEHAC works with the local community for such vulnerable populations, enabling them to avail free and comprehensive mental health care in as accessible a manner as possible. This case report depicts an integrated community-based approach in delivering psychosocial care for a pregnant woman with an existing diagnosis of bipolar affective disorder. Client's vulnerabilities were further multiplied by family pathology which resulted in ineptitude of key decision-makers and absence of protective factors such as supportive family members and lack of financial support. The resultant constraints made the involvement of community imperative in delivery of care during her perinatal period. Different stakeholders such as health workers at various levels in the health-care system, community volunteers, and local self-government representatives were mobilized and involved to facilitate psychosocial interventions. The outcome included ensuring access to effective care even in times of COVID-19, reintegrating with family of procreation and facilitating a supportive network between family of origin and immediate community. MEHAC's model of fostering community ownership enabled effective utilization of ground support and ensured intersectoral cooperation to deliver compassionate and holistic care. Inclusive involvement of the community at multiple levels enhances participation in patient care and reduces the burden of mental illness for the patient and caregivers.
| Telepsychiatry Becoming a Pathway to Reduce Stigma and to Uncover the Sensitive Mental Issues | | |
Ankit Kumar Sinha, Shree Mishra, Susanta Kumar Padhy
AIIMS, Bhubaneshwar, Odisha, India
E-mail: [email protected]
Abstract
Introduction: Over the last two decades, the era of digital revolution has changed the psychiatric clinical practice. Telepsychiatry is the use of information technologies and electronic communication to deliver clinical psychiatric care to those who are at a distance. In the current scenario of COVID pandemic, the reduced in-person visits due to wide duration of travel restriction have progressively increased the wide usage of telepsychiatry. In this article, we tried to highlight the impact of telepsychiatry in making people to come forward for their problems which remain under the blanket due to stigma in the society. Telepsychiatry has become the easily available option for those who stay in the remote and isolated areas. Treatment for mental health is still a stigma among the general population due to perception of critical appraisal by the society. Telepsychiatry in somehow has reduced this stigma as it becomes confidential for those who do not want to share their details; hence, the privacy and the anonymity remains intact. There are certain sensitive issues related to sexuality, suicidality, depression, substance use, excessive media use by children, etc., which most of the times remain hidden due to stigma or possibly due to unawareness about the mental health issues. In such scenario, telepsychiatry has been of great help. While a lot of mental health discussion mostly focuses on the younger population, as in terms of academic pressure, the older age group having the multiple health issues often overlooked. Telepsychiatry has become the effective way to tackle the problems of this age group. Conclusion: Even at a slower pace, telepsychiatry is having a great positive impact in reducing the stigma related to sensitive mental issues in the society.
| Clinical Profile of Patients Receiving Continuation Electroconvulsive Therapy: A 10-Year Retrospective Study | | |
Sanjana Kathiravan, Sandeep Grover, Subho Chakrabarti
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: There is a lack of data on the use of continuation electroconvulsive therapy (ECT) from India. Objectives: This study aimed to evaluate the clinical profile and outcome of patients receiving continuation ECT in severe mental illness. Methods: The ECT register was used to identify patients receiving continuation ECT (ECT after completion of acute course, to maintain remission or prevent relapse) during 2011–2021. Sociodemographic, clinical, and treatment outcome details were extracted from their treatment records. Sixty continuation ECT courses were identified, used in 49 patients. Results: Majority of the patients were male (58.3%), single (56.7%), unemployed (66.7%), belonged to Hindu religion (70%), middle socioeconomic status (91.7%), and from urban background (66.7%). Their mean age at the starting of ECT was around 40 years. The most common diagnosis was schizophrenia (75%) followed by recurrent depressive disorder (18.3%). The most common indication was persistent psychotic symptoms poorly responding to multiple antipsychotic trials (mean: 3.33, standard deviation [SD]: 1.37), including clozapine. These patients received a mean of 22.62 (SD: 8.02; range 10–40) ECTs, with 9.93 (SD: 4.41) acute phase ECTs and 12.68 (SD: 6.52) ECTs as part of continuation treatment. Majority (66.7%) of the patients received four continuation ECTs in the 1st month, followed by 2 more in the next month. However, 16 patients received weekly ECTs during the 2nd month too, as symptoms worsened with lower frequencies. Ten patients received more than one continuation ECT courses. In twenty patients, continuation ECT was followed by maintenance ECT. Majority of the patients maintained improvement gained during acute phase or showed further improvement with continuation ECT along with ongoing pharmacotherapy as rated on appropriate scales. Conclusion: Continuation ECT is considered in only in small proportion of patients. However, when used, it is effective in maintaining the benefits gained during the acute course of ECT and preventing relapse.
| Translating the Female Sexual Function Index: Learning and Challenges | | |
Sanjukta Ghosh, Snehil Gupta, Abhijit Rozatkar, Roshan F Sutar, Sai Sreeja Vullanki
AIIMS, Bhopal, Madhya Pradesh, India
E-mail: [email protected]
Abstract
Introduction: Sexual dysfunctions (SDs) are common among females suffering from common mental disorders, which could be part of psychiatric disorders itself or an adverse effect of psychotropic medications. Despite this, it is an underdiagnosed and undertreated condition, particularly in countries like India that is partly attributed to lack of a standardized instrument. Objectives: The current study is aimed to translate the Female Sexual Function Index (FSFI), the most commonly used tool to assess SDs among females, into Hindi and validate it. In this paper, we would be highlighting the process of translation and back translation of the FSFI. Methods: The translation-back translation would be performed as per the guidelines of the World Health Organization and literature: forward translation (two translators, discrepancy would be addressed by the third unbiased bilingual translator), backward translation (two translators, not aware about the concept), expert committee de-briefing (n = 5 experts on subject matter to review the semantics, idiomatic, conceptual equivalence, etc., of the translations), and preliminary pilot testing of the prefinal version of the scale through cognitive interviewing (n = 25–30 participants) (to elaborate what they thought each questionnaire item and their corresponding response meant). The findings would be depicted in terms of challenges during the forward and back translation, recommendations by the expert panel, problems found during the pretesting of the instrument, and the subsequent modifications. Results: Till now, forward translation of the FSFI has been done by two lay bilingual translators. The discrepancies between the two translations (items of the questionnaire, semantics, etc.) were resolved with the opinion of an independent translator. The rest of the findings would be presented in conference. Conclusion: The findings of the paper would be highlighting the process of translation of the FSFI and challenges associated with Indian context where females do not come forth well with sexuality or related dysfunctions, thereby guiding the future researchers for latter's wider research.
| Are Indian Medical Postgraduates Knowledgeable and Comfortable about Sexual History Taking in Patients? | | |
Rashmi Singh, Neena Sawant
Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
E-mail: [email protected]
Abstract
Background: The current medical curriculum for both undergraduates and postgraduates is deficient as it does not address the relevant aspects resulting in incomplete training and avoidance of asking about sexual health in routine clinical practice. Objective: We undertook this research to study the existing knowledge and comfort while taking sexual history, as well as managing the sex-related problems in patients by the medical postgraduates. Methods: Two hundred medical residents were recruited in the study after informed consent and ethics approval. Residents in I/II/III year or doing senior residency in only clinical disciplines were enrolled after systematic sampling. A semi-structured pro forma was used to collect information on knowledge, comfort, and training in sexual health with the help of open- and closed-ended questions. Results: All knew about menstrual and reproductive health, 70% had knowledge about anatomy and sexual response cycle and 40% about sexual dysfunctions or its treatment. Seventy-six percent expressed no adequate training was given and 96% felt that the lectures on sexual medicine were less useful. 91% wanted training using videotapes, roleplays, and group discussions. Sixty-eight percent were comfortable talking about sexual problems to patients of the same sex and 27% to the opposite sex. Ninety-eight percent gave inability to maintain privacy and confidentiality while sexual history taking in both OPD and indoor settings. Routine enquiry into sexual complaints was done by only 7% of the residents, though 60% gave importance to understanding aspects of their patients' sexual history. Conclusion: Our study has highlighted some of the existing lacunae in the current Indian educational system with regard to sexual health, the existing knowledge, and comfort of the postgraduates. Curriculum changes with an importance to sexual health and increased training are therefore necessary in today's times.
| Worsening of Sexual Dysfunction and Development of Dependence to Kamini Vidrawan Ras (An Ayurvedic Aphrodisiac): A Case of Double Jeopardy | | |
B K Gracy, Mini Sharma, Nitin Raut
Lady Hardinge Medical College, New Delhi, India
E-mail: [email protected]
Abstract
Introduction: We present a case of dependence to Kamini Vidrawan Ras an ayurvedic preparation prescribed inadvertently for variety of sexual problems, which in this case unfortunately worsened the sexual problems of the patient. Case History: A 50-year-old male presented with history of consumption of Kamini Vidrawan Ras for the past 15 years in gradually increasing amount starting from 2 per day to current 15–20 per day (initially due to high and later on due to withdrawal symptoms such as stuffy nose, lacrimation, feverish, restlessness, and weakness). Further, his symptoms of erectile dysfunction and premature ejaculation worsened further in the last few years. Since this was affecting his health and quality of marital life, the patient consulted the department of psychiatry of our institute. On evaluation, symptoms were suggestive of opioid withdrawal with COWS score of 12. He responded well to total 6 mg of buprenorphine. After 1 week, his withdrawal symptoms had subsided and our plan was to gradually taper and monitor for further course of action. Discussion: There are several case reports from India as well as other countries of abuse of ayurvedic preparation containing illicit opioids. There has been a rise in abuse of such preparations due to lack of regulation over their sale. Through this case, we intend to depict abuse potential and side effects of herbal medications containing opium, with evident health-related and legal implications. Conclusion: This case report highlights the need of exploring for the use of such preparations as clinicians, need of raising consumer awareness, stringent application of drug laws, and scientific basis of approving alternative medicines.
| Treatment-Seeking Behavior among Injection Drug Users: A Retrospective Chart Review Study in North India | | |
Sunila Rathee
Institute of Mental Health, University of Health Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Introduction and Aim: Injecting drug users (IDUs) are among the most vulnerable people to acquisition of HIV/AIDS. Nationally, it is estimated that there are about 8.5 lakh people who inject drugs (PWID). Opioid group of drugs is predominantly injected by PWID (heroin – 46% and pharmaceutical opioids – 46%). A substantial proportion of PWID report risky injecting practices. High numbers of PWID are estimated in Uttar Pradesh, Punjab, Delhi, Andhra Pradesh, Telangana, Haryana, Karnataka, Maharashtra, Manipur, and Nagaland. This study aims to collect information on IDUs and their health-seeking behavior in North India. Methods: The present study is a retrospective chart review from the State Drug Dependence Treatment Centre, Institute of Mental Health. We reviewed hospital records of 225 patients registered in the center from January to December 2019 for treatment of injection drug abuse and were evaluated by prestructured pro forma consisting of questions regarding: sociodemographics, age of onset, reason of initiation, and risk-taking behavior regarding injection use. Results: During this period, around 2347 patients sought consultation, of whom 1078 were patients of opioid dependence (45.9%) and 20.8% were taking opioid through intravenous route, and history of sharing of needles and syringes were found among 4.4% of the patients. The mean age of patients was 26.53 years; the majority of IDUs were male and married and were educated up to higher secondary. In occupation, most of the patients were unemployed (42.4%) while 30.8% were self-employed. More than half of the patients belonged to nuclear families (52.8%). Majority (58.4%) of patients were from the urban background. Majority of the patients were accompanied by their family members (58%) and 16.5% were brought by his family members for treatment while 70.3% were by their own initiative. The most common drug injected was heroin (80%) followed by buprenorphine. High-risk behaviors were common and included needle sharing, unsafe disposal, and inappropriate cleaning of needles. Results: The median (interquartile range) age of the participants was 33 (27–38) years, respectively, with only 9.2% females. Injection buprenorphine was the drug of choice for 40% of participants, and 58% of the participants first started drug use with smoking cannabis. 73.3% of participants shared needles sometimes and 57.5% were willing to use the needle exchange programs. Sixty percent of the participants had no knowledge about the diseases spread by injection. Condom use during the last intercourse with regular partners was 11.7% and with any partners 15.8%. Over 1 year (January 2019–December 2019), a total of 1079 patients with opioid use disorder were included in the study. The mean age of patients was 28.53 years. Nearly half of patients (46.9%) were between 20 and 29 years of age group. Most of the patients were males (99.3%), majority (45.7%) were educated up to higher secondary, and 5.7% were not formally educated. In occupation, most of the patients were unemployed (42.4%). Conclusion: Education and interventions specifically aimed at IDUs are needed, because traditional education may not reach IDUs or influence their behavior. IDUs in India need to be educated on harm reduction and safe-injection practices.
| Perspectives on Domestic Violence in Japan: A Review Study of Court Precedent for Marital Lawsuits | | |
Shiro Suda, Junko Morishita, Manabu Yasuda, Toshiyuki Kobayashi
Department of Psychiatry, Jichi Medical University, Shimotsuke, Japan
E-mail: [email protected]
Abstract
Background: Support systems for domestic violence (DV) victims in Japan are focused exclusively on female victims, and male victims are still neglected. Objectives: The objective of this study was to investigate the actual status of DV in marital relationships in Japan. Methods: This was a retrospective, observational court precedent review of DV cases in Japan. Victims of DV who took legal actions from 1950 to 2018 were included in the study (169 women and 103 men). The following data were obtained from the case database of the Japanese court: the trial outcomes, the forms of violence that were adjudicated guilty, and the presence/absence of acts of unchastity. The forms of violence were classified into six categories (physical violence, psychological violence, economic violence, social violence, neglect, and sexual violence). Chi-square tests were used to evaluate the significance of differences in the forms of violence by gender, with P < 0.05 considered significant. Results: Male victims were found to lose a right of claim for divorce more significantly than female victims. In the Japanese court system, victims of DV in marital relationships were significantly more likely to be female than male, with higher rate of winning lawsuit. The most common form of violence in female victims was physical violence, followed by economic violence. On the other hand, in male victims, the most common form was psychological violence, followed by neglect. With regard to the details of violence, harassment, abandonment of care nursing, threat, yelling/threatening in the victim's workplace, constant observation, and stealing/forced disclosure of letters, E-mails, and cell phone records were more prominent in male victims. Conclusion: In Japan, the forms of DV differ by gender, and male victims are more frequently exposed to psychological violence and social violence. This suggests that specific legislation dedicated to male victims is warranted.
| Landau–Kleffner Syndrome with Behavioral Disturbances: A Case Report | | |
Dron Kinnarbhai Bhandutia, H S Dhanashree Akshatha, M T Sathyanarayana
Sri Siddhartha Medical College, Tumkur, Karnataka, India
E-mail: [email protected]
Abstract
Introduction: Landau–Kleffner syndrome (LKS) is a rare childhood disorder characterized by loss of language comprehension and verbal expression. It presents as an acquired aphasia associated with convulsive disorder. This disorder being relatively uncommon, frequency becomes questionable and hence increases chances of misdiagnosis. With very few cases in literature, we report a case of LKS with behavioral disorder not otherwise specified. Case Description: A 6-year-old boy, the second born of a nonconsanguineous marriage with family history of seizure disorder in third-degree relative, intellectual disability with seizure in third-degree relative, was brought by mother with hyperactivity, impulsivity, inattentiveness, defiance toward parents, regression in speech, and language after 2½ years post the first episode of seizure. His developmental milestones were normal until 2½ years of age. Following this, there was a regression of speech, with receptive and expressive aphasia within 6 months after an episode of complex partial seizure characterized by left focal seizure with twitching of mouth to the left and blinking of left eye with unresponsiveness lasting few seconds. He has intact socioemotional reciprocity, including nonverbal gestures, reciprocal social smile, and initiative for joint play. His intelligence clinically seems average. He was started on pulse of methylprednisolone, which he is receiving from the past 3 years. There was gradual improvement in word output, naming with increase in number of words used, with irritability and hyperactivity persisting. He was started on syrup valproate, tablet clobazam, and tablet arkamin. Since lockdown, only syrup valproate was continued and was brought with worsening of behavioral problems. He was negative for IgG to measles virus. His electroencephalogram was grossly abnormal and magnetic resonance imaging did not reveal any significant abnormality. Hearing assessment was reported normal. Behavioral disturbances were addressed. Repeat EEG showed persistent epileptiform activity.
| A Tuberculoma Facade: A Peculiar Presentation of Depression | | |
Jerin Mathew Jose, Sivin P Sam, Roy Abraham Kallivayalil, S Sheetal
Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
E-mail: [email protected]
Abstract
Tuberculosis can involve different parts of the central nervous system primarily via hematogenous spread of Mycobacterium tuberculosis. One group of manifestation of tuberculosis of the nervous system is tuberculoma. These are uncommon forms of tuberculosis occurring as masses, made up of small tubercles with epithelioid cell core and surrounding lymphocytes either single or multiple. The most common locations of tuberculomas are cerebellum and brainstem. However, when tuberculomas involve the frontal lobe, they cause changes in the personality and behavior and can even present as a psychiatric disorder without any neurological symptoms. These changes may be the core presenting feature of such diseases often delaying the diagnosis of a mass lesion in the brain. We report the case of a 56-year-old female, with no past history of psychiatric illness, who presented to the neuromedicine outpatient department with headache, vomiting, and depressive symptoms. On examination, she was noted to have left-sided neck swelling. Along with imaging, psychiatric consultation was sought in view of predominant depressive symptoms. Magnetic resonance imaging brain revealed multiple ring-enhancing lesions in the left frontal region (largest – 2.1 cm× 1.7 cm × 1.9 cm) with both solid and cystic components and diffusion restriction representing multiple abscess formation and surrounding edema suggestive of tuberculoma and meningoencephalitis. Magnetic resonance venogram was also consistent with the diagnosis. Further blood investigations showed an elevated erythrocyte sedimentation rate. CSF study revealed lymphocyte predominance and MTB (CBNAAT). Along with antitubercular treatment (ATT), she was started on tablet escitalopram, tablet risperidone, oral steroids, antiemetics, and oral antiepileptics. Post ATT, the patient showed a decrease in depressive symptoms including disinhibitory behavior, and the quality of life has improved.
| Innovation in Legislation Dormancy in Nation: Indian Outlook | | |
Mini Sharma, Nitin Raut
Lady Hardinge Medical College, New Delhi, India
E-mail: [email protected]
Abstract
Background: A significant proportion (10.6%) of Indian population suffers from mental illness, huge treatment gap (83%), and disability due to mental illness up to an extent of 70%. Despite these alarming statistics, the rehabilitation and community care for the person with mental illness is not sufficient. Indian Outlook: Speaking about the advancements in the field of social and community psychiatry revolutionary changes has been done back since 1912 deinstitutionalization to the present era of Mental Healthcare Act 17 enforcing the rights of persons with mental illness (PMI) as human. Furthermore, there has been advancement in the care and rehabilitation of PMI via the National Mental Health Program, District Mental Health Program, Taluka Mental Health Program, and telepsychiatry; along with progressive amendments of policies for persons with disabilities such as Rights of Persons with Disabilities Act, National Trust Act, Rights of Persons with Disabilities (online forums), Sugamya Bharat App, and Kiran helpline. Regardless of the advances and innovation at taluka and national level, a minor fraction of utility and improvement have been noted. Future Direction: There is a need of grassroot level implementation involving building up a skill force team, IEC activity, community participation not just at policy desk but in ground reality. The following measures could be helpful in up pacing with the advancements: 1: enable access to all mainstream systems and services, 2: invest in programs and services for people with disabilities, 3: adopt a national disability strategy and plan of action, 4: involve people with disabilities, 5: improve human resource capacity to utilize present policies and facilities 6: provide adequate funding and improve affordability, 7: increase public awareness and understanding about disability, 8: improve the availability and quality of data on disability, 9: improvised and functional mobile mental health units in collaboration local nongovernmental organization, private hospitals, and political parties, and 10: strengthen and support research on disability.
| Intercultural Communication in Psychiatric Diagnosis and Psychiatric Consultations | | |
Janis Chen, Raghu Raghavan, Brian Brown, Zoe Palfreyman, Nandini Chakraborty
Mary Seacole Research Centre, De Montfort University, Leicester, England, United Kingdom
E-mail: [email protected]
Abstract
Background: There is growth in recognizing the importance of psychiatrists' cultural understanding of their patients' backgrounds, expressions of their illness, and lived experiences. Numerous studies have identified that cultures affect health communications in clinical encounters; however, different barriers may constrain practitioners' ability to make proper diagnoses. Moreover, psychiatrists follow diagnostic guidelines in making sense of the symptoms; nonetheless, the diagnostic categories may perform inappropriately with cultural variables and norms. Consequently, patients may receive poor diagnostic outcomes and mental health services. Objectives: This study explores what cultural aspects were considered in diagnostic interviews and how psychiatrists utilize their cultural awareness, cultural knowledge, and cultural skills during a psychiatric diagnostic consultation interview process. Methods: A literature search of the electronic database was undertaken on Academic Search Premier, APA PsycInfo, APA PsycArticles, CINAHL, and MEDLINE in three searching terms for English-published journal articles from January 2010 to November 2020. A total of 217 articles were retrieved. An additional search of psychiatrists and authors of the diagnostic classification system on their studies was applied. In total, 37 articles were selected for a thorough review. Results: A consensus exists in the literature that patients' experiences will be influenced by psychiatrists' cultural awareness and skills. It is still unclear which cultural skills and knowledge psychiatrists are required and how they utilize these cultural abilities in a psychiatric interview in today's changing nature of psychiatric practice in the UK. Conclusion: Psychiatrists require appropriate intercultural communication skills in conducting reliable and clinically useful diagnostic consultation interviews. A guideline of intercultural communication skills should be employed to improve diagnostic outcomes and mental health services.
| “The Artist with Bleeding Fingers:” A Rare Case of Body Integrity Identity Disorder Co-occurring with Bipolar Affective Disorder | | |
Sangeetha Vincent
MOSC Medical College, Kochi, Kerala, India
E-mail: [email protected]
Abstract
Body integrity identity disorder (BIID) or apotemnophilia refers to a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. Patients suffering from this disorder have a mismatch between their actual and perceived body schema, and they feel that being an amputee is a necessary and important aspect of their identity. In a good majority, these intense and intrusive thoughts to amputate a limb were related to sexual fantasies and sexual arousal. Some have associated sexual fantasies and arousals directed to other people who have lost a limb or body part – this is termed acrotomophilia or allo-apotemnophilia, also known as deformation fetishism. Here, we report the unique case of a 45-year-old artist with BIID and acrotomophilia, having comorbid bipolar affective disorder (BPAD). Years back, during a manic episode, he had self-amputated his left thumb. During BPAD remissions, he had defended such impulses by removing his toenails instead of fingers. Due to the peculiar interpersonal dynamics shared with him, his wife as well as another partner had self-amputated one of their fingers, without his coercion, as a “token of love” toward him. Currently, during mania, he presented to ER with intense suicidal ideas, following intolerable impulses to self-amputate his right thumb. He hoped a surgeon would “neatly” solve his issue. We wanted to draw attention to the complexities involved in managing his psychopathology and the associated ethical dilemmas, as well as the impact of healthy limb amputation on the sociocultural milieu of a country like India.
| A Case Report of Mania First Episode in the Elderly – Neuropsychiatric Manifestation of COVID | | |
Mondeep Dhankar, Mini Sharma
IHBAS, Delhi, India
E-mail: [email protected]
Abstract
Background: COVID-19 infection is commonly associated with multisystem involvement. It mainly affects digestive and respiratory system. However, it can also affect central nervous system inducing neuropsychiatric manifestation. Our understanding of the neuropsychiatric manifestations of COVID-19 is still evolving. Case Report: A 74-year-old, previously healthy, male patient presented with fever, myalgia, and sore throat for the last 4 days. He tested positive for COVID-19 by RT-PCR. In view of his age, he was admitted to an isolation facility. His vitals were stable throughout hospital stay, and there was no respiratory involvement on chest radiology. Investigations suggested neutrophilic leukocytosis and a significant increase in inflammatory markers such as C-reactive protein (26 mg/dl) and interleukin-6 (50 pg/ml). Other blood parameters including electrolytes and renal and liver function tests were normal. He was treated for mild symptoms as per government-approved protocol. Five days after hospitalization, the patient was clinically better, but inflammatory markers were still elevated. He was discharged for home isolation. Second day, post discharge gradually, he started having significant sleep impairment and developed overt talkativeness. By the 5th day, symptoms progressed to increased physical activity, big talks, and disinhibited behavior. He was brought to psychiatric emergency. Magnetic resonance imaging brain with contrast suggested age-related demyelination. Further evaluation revealed that he was in clear consciousness state with marked physical aggression, overfamiliar behavior, and big talks. He did not have any previous or family history of psychiatric illness. Based on these findings, a clinical diagnosis of first episode of mania with psychotic features, fulfilling the International Classification of Diseases criteria, was made. He was started on olanzapine, and he started showing improvement in symptoms. Conclusion: This is a unique case of mild COVID infection, precipitating acute mania in an otherwise healthy geriatric patient. Mania first episode in the elderly is rarely reported. The pathophysiology and exact management of such COVID-related psychiatric disorders will be clearer in the times to come.
| Assessment of burnout in health-care workers in COVID-19 pandemic in the state of Himachal Pradesh | | |
Simran Gupta, Rewa Sood, Dinesh Dutt Sharma
Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
E-mail: [email protected]
Abstract
Background: The World Health Organization declared COVID-19 as a pandemic on March 11, 2021. It has the potential to significantly affect the mental health of frontline health-care workers in this hour of crisis. According to a consensus, health-care professionals are at an increased risk of burnout which could have long-term psychological implications. Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. Working as a frontline worker in a global pandemic with high workload and limited resources leads to an emotionally and physically exhausted state. Thus, mental well-being of health-care professionals needs to be strengthened. Objective: The aim is to assess burnout in health-care workers in COVID-19 pandemic in the state of Himachal Pradesh. Materials and Methods: A cross-sectional study was conducted after taking informed consent with the help of Google Forms. The Maslach Burnout Inventory by Maslach et al. (1996) was used along with sociodemographic variables for the assessment. Results: Among the 174 participants, in section A (Burnout), 53.45% had low burnout, 30.46% had moderate burnout, and 16.09% had high burnout; in section B (Depersonalization), 28.16% had low burnout, 32.76% had moderate burnout, and 39.08% had high burnout; in section C (Personal Achievement), 21.84% had low burnout, 23.56% had moderate burnout, and 54.60% had high burnout. Conclusion: Hence, consideration to implement strategies supporting the health-care workers to understand crisis management, self-mental health care, and other principal measures to strengthen their coping skills and mental preparedness along with providing abundant care to their mental health is needed.
| Management of Cognitive Impairments in Recovered COVID-19 Patient: A Case Study | | |
Poonam Gupta, Preeti Singh, Rajiv Gupta
Institute of Mental Health PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: COVID-19 caused by SARS-CoV-2 has killed millions of people across the world in less than a year. It has affected almost all of the human population directly or indirectly. A large proportion of patients experience persistent cognitive problems with memory difficulties and impaired ability to concentrate for several months after their recovery from COVID-19. Hence, the need for early identification is necessary and may directly influence the successful management of cognitive impairments. Aim: The present study aims to evaluate the pattern of cognitive impairments in recovered COVID-19 patients and management. Case Study: Mr. A, 45-year-old, postgraduate, married, belongs to middle socioeconomic status and teacher by profession, came 4 months after his recovery from COVID-19 with the chief complaints of irritation, difficulty in concentrating on his work, memory difficulties, and low self-confidence, in the Department of Psychiatry, IMH, Rohtak, for treatment and management. Methods: For this purpose, a neuropsychological assessment, i.e., Trail Making Test (Reitan, 1958) for attention and concentration and PGI Memory Scale (Parshad and Wig, 1977) for memory functions, was administered. After assessment, a manualized cognitive retraining module focusing on attention and memory-related impairments was applied. A total of 16 sessions (2 per week) of cognitive retraining was given for attention and memory functions. After cognitive retraining, the patient was reassessed. Results: Mild cognitive impairments were found in both attention and concentration and memory functions. Findings revealed improvement in attention and concentration, memory functions, personal, social, occupational performance, and subjective well-being. Conclusion: There are important clinical needs that can be addressed by research aimed at demonstrating whether improved detection results in improved outcome.
| Awareness and Challenges in Psychiatric Advance Directives among Mental Health Professionals | | |
Aparna Goyal, Shipra Singh, Neha Aggarwal
Institute of Mental Health, Pt B D Sharma UHS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Introduction: Rights of mentally ill are often seen to be impeded on account of their diminished capacity. However, India in compliance to UNCRPD brought the concept of psychiatric advance directive (PAD) through Mental Healthcare Act to emphasize its commitment to preserve integrity and rights of mentally ill. However, PADs in a country like India, illiteracy, ignorance, lack of awareness, insufficient knowledge and stigma toward mental illness can make its implementation difficult. This study is designed to assess the awareness and issues faced by mental health professionals regarding PAD. Methodology: Mental health professionals such as psychiatrist, psychologist, psychiatric social workers, psychiatric nursing staff, occupation therapist, and MHP trainees working at a tertiary care hospital will be approached for the study. Informed consent will be taken and sociodemographic details will be collected in a specially designed pro forma. Understanding related to PAD and its implementation will be asked through a questionnaire designed for the study. Results: To be discussed in the final presentation. Conclusion: Issues in implementation of PADs need to be looked into so as to advocate the rights of mentally ill persons.
| A Comparative Study of Complement Biomarkers in Schizophrenic Patients | | |
R K Solanki, Ranjana Solanki, J P Pankaj, Rishika Agarwal, Anu Shekhawat, Kuldeep Singh Yadav
Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
E-mail: [email protected]
Abstract
Schizophrenia is a complex disorder involving dysregulation of multiple pathways. Apart from several etiological factors such as genetic, infection, and environmental factors implicated in causing schizophrenia, there is a focus on complement dysregulation in the disease. In the present study, an attempt was made to study the concentration levels of complement factors (C3, CR1, C5, C4, and C1INH) as a preliminary information so as to know their role in Indian population. The goal of the current study was: (1) to find out effects of dysregulation of complement factors in schizophrenic patients; (2) for confirming and making an early diagnosis for high-risk patients (first-degree relatives) using the analysis of these complement factors; and (3) to investigate the potential of using complement-related proteins as serum biomarkers to provide an insight into etiology with prognostic and/or theranostic value in schizophrenic patients and also their first-degree relatives. A cross-sectional, analytic study was conducted at tertiary center of North India in collaboration of multidisciplinary research unit. Thirty-two patients who met the International Classification of Diseases-10 criteria for schizophrenia and fulfilling the inclusion and exclusion criteria were recruited after written consents from patients and their first-degree relatives. Thirty-two first-degree relatives accompanying the patients and 16 healthy controls were also included in the study. A significant lower mean value of C4 and CR1 was observed in schizophrenic patients than control, and significant dysregulation was seen in various complement factors with respect to certain sociodemographic profile such as family type, family size, and birth order. No significant dysregulation of complements was observed in first-degree relatives.
| Media Reporting and Suicide at COVID Times | | |
Adwitiya Ray, Purushottam Jangir, Priti Singh, Rajiv Gupta
Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: Associations between sensational news coverage of suicide and subsequent increases in suicidal behavior in the general population have been well documented. Amid growing concern over the impact of the COVID-19 pandemic on suicide rates, it is especially important that news coverage of suicidal behavior adheres to recommended standards for the responsible reporting of suicide. Objectives: To analyze the content of suicide news reports, assess their adherence to reporting guidelines, and compare them between the two waves of the pandemic. Methods: This study used a systematic search of online news media reports between the dates March 24 and May 3 for the years 2020 and 2021 using keywords: suicide, self-harm, attempted suicide, kills self, and hangs self. Using a set of dimensions based on international media guidelines, the quality and content of news reports of possible COVID-19 suicides were analyzed. Results: A total of 1215 and 1325 articles were retrieved for the years 2020 and 2021, respectively, out of which 65 articles were possibly related to COVID in 2020 and 27 in 2021. The majority of the newspapers in 2020 (98.5%), as well as 2021(81.5%), made an explicit link between suicidal behavior and COVID-19 using terms such as “lockdown” or using images, mostly based on statements of family, neighbors, and police. Harmful reporting practices such as using the word suicide in headlines and using an image of location were more in 2020 compared to 2021, while good reporting practices such as providing suicide helpline numbers were rare. Conclusion: While news reporting has improved compared to earlier coverage of suicide in India, careful attention must be paid to the quality and content of reports, especially as long-term consequences of the COVID-19 pandemic develop.
| Telementoring of Rural Health Organisers of Chhattisgarh: Reaching the Unreached | | |
K Pushpa, R Arun Kumar, Praveen Pandey, Monika Thakur, Malathesh Barikar, N Manjunatha, C Naveen Kumar, Suresh Bada Math, Sumi Jain
NIMHANS, Bengaluru, Karnataka, India
E-mail: [email protected]
Abstract
Background: About two-third of the Indian population lives in rural areas. Lack of awareness, stigma, and unavailability of trained mental health resource are major challenges in bridging the burgeoning mental health treatment gap. Chhattisgarh has 10,500 rural health organizers (RHOs) comprising ANMs and MPWs. Enabling the RHOs in screening and referral of common mental illnesses can have a domino effect in improved awareness of psychiatric illnesses in community and facilitate access to services at various levels of referral. Objectives: To train all the 10,500 RHOs of Chhattisgarh in screening, counseling and referral of persons with mental health concerns in the community. Methodology: The training consists of basic and advanced modules of 12 online sessions each, covered in 48 h over a period of 24 weeks. Along with didactics and case scenario discussion, the focus is on experience sharing and continuous hand-holding with the RHOs. Mental Health Screening and Counselling for Field Level Workers of India (MERIT) tool is used for screening patients for commonly occurring mental disorders. The RHOs screen all the patients visiting the subcenter and patients encountered during their field visit using MERIT tool and discuss the findings with nursing informatics via video conferencing and refer them to the nearest available higher health center. Results: The Telementoring of Rural Health Organisers of Chhattisgarh project started in January 2020, and Surguja was the first district to be incorporated with an aim to train all the RHOs in Chhattisgarh in the next 3 years. The training of RHOs can promote accessibility, acceptability, affordability, and scalability of services by promoting adherence to treatment and increase the likelihood of positive clinical outcomes. Conclusion: The provision of mental health training for the RHOs through the cost-effective and innovative use of technology in building clinical skills is the next step in realizing the dream of mental health care for all.
| COVID-19 “Anxiety Syndrome:” A Case of “Coronaphobia” with Internet Gaming Disorder | | |
Ashlyn Tom, Nishtha Chawla, Mamta Sood
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: COVID-19 pandemic and the uncertainties/fear associated with it still continue to persist. Significant mental health impact has been associated, including worsening of preexisting psychiatric illness, or development of new symptoms. Internet gaming has been identified as a common way of coping during the pandemic. “Coronaphobia” and COVID-19 “anxiety syndrome” are recently described phenomenon in the context of development of de novo psychiatric symptoms during the pandemic. Objective: We aim to present the case of a young male who developed “coronaphobia” and subsequently Internet gaming disorder. Methods: A 24-year-old unmarried, graduate male with no past or family history of psychiatric illness presented with 9 months history of acute-onset symptoms, characterized by anxiety symptoms including panic attacks, excessive fear of contracting COVID-19, and avoidance behavior. This was followed, subsequently after about 2 months of onset by persistent and recurrent use of online games which would help him relieve the anxiety symptoms. It was associated with preoccupation, tolerance, unsuccessful attempts to control, and withdrawal symptoms when he would be barred from gaming, leading to significant sociooccupational dysfunction. Results: His physical examination and routine blood investigations were unremarkable. He was started on tablet escitalopram build up to 10 mg, along with tablet propranolol 20 mg, and clonazepam 0.25 mg twice a day. A significant reduction in his symptoms occurred over the next 1 month. Conclusion: “Coronaphobia” is a phenomenon recently described by some authors as excessive fear related to catching COVID-19 infection and dying of it. COVID-19 anxiety syndrome encompasses these symptoms along with maladaptive coping, like Internet gaming disorder in our case. It is important for the clinicians to identify and treat such cases at the earliest to avoid secondary consequences.
| Internet Gaming Disorder in a Vulnerable Child during COVID-19 Lockdown: An Interesting Case Report | | |
Kajal Taneja, Sidharth Arya, Sunila Rathee, Rajiv Gupta
Institute of Mental Health, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Background: COVID-19 pandemic has led to an increase in the time spent by children indoors that have resulted in a greater digital screen time. There is limited socializing with peers and restricted supervision by parents due to online schooling that predisposes the vulnerable children to online gaming. Internet gaming disorder has associated health risks (for example – sleep disturbance, neck pain, headaches, etc.) and exposes children to cyberbullying. Aim: To discuss the development of Internet gaming disorder emerging from psychosocial stressors arising due to COVID-19. Case Discussion: A 12-year-old child with a history of bullying at school and social anxiety started spending excessive time on playing online games. The involvement increased to an extent that his biological functions, self-care, interaction with family, and academic performance deteriorated. It took a huge toll of financial expense of 12,000 rupees. He had difficulty in controlling anger outbursts as a result. Parents, school authorities, gaming companies, and policymakers have a responsibility to take action to ensure online safety for young people during COVID-19. Conclusion: Social isolation and increased digital screen exposure is a risk factor for developing gaming disorder and further gambling disorder. This highlights the need for the development of support and enhancement of online safety norms for children.
| The “FIT” Model – An Innovation in Mental Health Coaching for Team Sports | | |
Stephy Stephan, Tinu Yohannan, Praveen Mathew Alexander, Johann Alex Ebenezer
Department of Distance Education, CMC, Vellore, Tamil Nadu, India
E-mail: [email protected]
Abstract
Background: The primary author was assigned as the mental health coach for a cohort of 16 young women who were enrolled in the Kerala Cricket Academy (KCA) Women's College Academy. Objectives: 1. To provide appropriately tailored mental health coaching interventions for the young women players in KCA. 2. To propose a model of mental health coaching for team sports. Methodology: The group was surveyed to collect demographics and better understand the various mental health issues faced. Lesson plans for interactive group teaching sessions were designed to sensitize regarding basic mental health issues. A follow-up plan was devised to provide continued support, both as a group and individually, with more intensive follow-up for those who needed it. The primary author carried out all these with academic and clinical advisory support from the co-authors. Results: Majority reported psychological symptoms such as attention difficulties (87.5%), hopelessness (93.75%), fear (50%), and anger (62.5%). One-third (6) reported suicidal thoughts. Very few expressed problems in sleep (25%), appetite (0%), and somatic symptoms such as headaches (25%), contrary to expected general population trends. The four group teaching sessions emphasized basic mental health awareness, identity, and team dynamics. All 16 were followed up at least once, 10 were retained till 18 months, and 4 required more intensive psychological interventions. Based on these experiences, we proposed the “FIT” model of mental health coaching for team sports which consists of “F” – finding and helping those with mental health issues, “I” – identity and mental well-being of the Individual for better performance, and “T” – team dynamics to promote mental health as a group. Conclusion: The “FIT” model plays on the strength of team sports by mobilizing strong team dynamics and individual well-being to enhance performance and strategically address unique mental health issues in the sports arena.
| Age at Death and Causes of Death of Patients Dying in Psychiatric Hospitals: Survey at 15 Hospitals in Tochigi Prefecture, Japan | | |
Manabu Yasuda, Toshiyuki Kobayashi, Kengo Sato, Nobuyoshi Saito, Shiro Suda
Jichi Medical University, Shimotsuke, Japan
E-mail: [email protected]
Abstract
Background: Japan entered an aging society in the late 1990s. The aging of inpatients in psychiatric hospitals has increased the need for medical care, but the actual situation has not been fully investigated. Objectives: We investigated the actual situation of inhospital deaths through death certificates. Methods: The survey was conducted at 15 of 26 psychiatric hospitals in Tochigi Prefecture, Japan, that consented to the survey. We examined the death certificates of patients who died between 1996 and 2015 at these 15 hospitals. The number of the certificates was 2441 (1443 males and 998 females). The number of deaths and the average age of death per year were calculated. Then, we surveyed the data regarding the diagnosis of death described in the death certificates based on the International Classification of Diseases-10. Results: The average age of death was in the 60s from 1996 to 2000 in the first 5 years, but since 2001, it has exceeded 70 years. Respiratory diseases accounted for 40% of the total, cardiovascular diseases for 26% and malignant neoplasms for 11%. On the other hand, extrinsic death such as suffocation was 4%, and suicide was 1%. Conclusions: The reason of elevation of death age might be related to the implementation of novel antipsychotics in Japan since 1996 and establishment of the long-term care insurance system for the elderly in 2000. It is considered that the reasons why respiratory diseases, cardiovascular diseases, and malignant neoplasms occupy the top ranks of death are these diseases with a high risk of death in the elderly. This study was carried out with the approval of the university's Clinical Research Ethics Committee.
| Social Functioning and the Quality of Life of Patients Diagnosed with Schizophrenia | | |
Nupur Kumari, Triptish Bhatia, Smita N Deshpande
ABVIMS and Dr RML Hospital, New Delhi, India
E-mail: [email protected]
Abstract
Social functioning considerably impacts the prognosis of schizophrenia patients. Quality of life is identified as a person's feeling of satisfaction and well-being with his/her living circumstances. Aim: This study focuses to evaluate the effects of social functioning as well as the quality of life of individuals with schizophrenia. Methodology: Schizophrenia outpatients (Diagnostic and Statistical Manual of Mental Disorders-5) were assessed on the Quality of Life Scale and one test from University of California San Diego Performance-Based Skill Assessment Brief edition. Results and conclusion would be discussed later.
| A Study on Impact of Blue Light of Smartphone on Sleep Quality among MBBS Students | | |
Navna Panchami Ravindran, Ankit Halder, Devavrat Harshe
D Y Patil Hospital and Research Institute, Pimpri-Chinchwad, Maharashtra, India
E-mail: [email protected]
Abstract
Background: Smartphone usage has increased considerably over the past two decades. Smartphone screens emit light rich in blue wavelength that has significant effects on neurophysiological functions. Objectives: The aim of this pilot study was to evaluate if the blue light emitted by smartphones affects the sleep quality in medical students. We decided to take an objective, telemetric approach to avoid any subjective raters' bias in reporting self-smartphone usage. Methods: Fifty students from third MBBS were examined for sleep quality with Pittsburgh Sleep Quality Inventory (PSQI). Their perceived smartphone usage was assessed with Smartphone Addiction Scale-Short Version. Telemetric apps were used to measure their cumulative smartphone usage and lock–unlock cycles in a predetermined 7-day period. Brightness of the smartphone screen was assessed with Lux-Meter-100k. Results: We found 50% of the students suffering sleep problems as per PSQI cutoff score. The mean cumulative smartphone usage was 2418 ± 1052 min and mean lock–unlock cycle count was 483 ± 216. Linear regression (F [2,47] = 8.625, P = 0.001) showed that bedtime (ß = −0.312, t = −2.497, P = 0.016) and smartphone usage post sunset (ß = 0.392, t = 3.134, P = 0.003) to be the only significant predictors of PSQI score. Significant correlation was found between daytime dysfunction subscale of the PSQI and cumulative smartphone usage (r = 0.435, P < 0.05) and total lock–unlock cycle count (r = 0.394, P < 0.05). Conclusions: Smartphone use affects sleep measures qualitatively and quantitatively. Continuous smartphone uses as well as intermittent exposure affects certain measures of sleep quality. Telemetric measurement of smartphone usage is an effective, simple, and objective method for smartphone research.
| Sexual Dysfunction in Hypertensive Females Affecting Different Domains – A Longitudinal Study | | |
Navna Panchami Ravindran, Ankit Halder, Devavrat Harshe
D Y Patil Hospital and Research Institute, Pimpri-Chinchwad, Maharashtra, India
E-mail: [email protected]
Abstract
Background: Patients with hypertension have a higher risk of developing sexual dysfunction. It can directly or indirectly affect various aspects of sexual functioning. Side effects of drugs may also aggravate these. Objectives: 1. To study the prevalence of sexual dysfunction in different domains in hypertensive females with sexual dysfunction. 2. To study the course of sexual dysfunction in those taking treatment for the same compared to those who are not. 3. To correlate the findings with age group, type of antihypertensive drug, and duration of antihypertensive therapy. Methods: All female patients presenting to the general medicine outpatient department, who (1) were diagnosed with primary hypertension, (2) were taking antihypertensives for a minimum period of 2 years, (3) did not have comorbid diabetes mellitus or endocrinological disorder, and neuropsychiatric disorders during the past 6 months, were included. Patients were assessed using the Female Sexual Function Index Questionnaire for dysfunction in different domains. Treatment options in the form of drugs and psychotherapy were provided for those afflicted, and were followed up after 6 months. Results: Our sample consisted of 48 females. The prevalence of 23% for females. The highest and lowest prevalence rates for SD were noted in patients taking beta-blockers (39%) and thiazide plus telmisartan combination (8%), respectively. Most domains were affected in those taking antihypertensives for more than 20 years (68%). Post intervention, domains that improved most were in desire domain (75%). Domains that were least affected were orgasmic function domain (83%). Conclusions: Sexual dysfunction is prevalent in hypertensive females significantly. The dysfunction is not only limited to erectile desire as it affects all the domains. Different antihypertensive agents cause SD in different spectrums. Post intervention, improvement is also domain specific.
| Relationship between Life Satisfaction and Psychological Characteristics in Community-Dwelling Oldest-Old in Tokyo, Japan | | |
Hisashi Kida, Hidehito Niimura, Yoko Eguchi, Kouta Suzuki, Shogyoku Bun, Midori Takayama, Masaru Mimuda
Keio University School of Medicine, Tokyo, Japan
E-mail: [email protected]
Abstract
Background: Japan is facing a number of issues relevant to a super-aged society, in which the population of oldest-old people increases even as the population declines. Among those issues, it is important for the oldest-old to increase their life satisfaction and reach the end of life. Objectives: We aimed to clarify the relationship between life satisfaction and psychological characteristics of oldest-old people, and explore the factors for achieving mental health and longevity. Methods: Questionnaire surveys and face-to-face interviews were conducted with oldest-old people (aged 85–87 years [85+] and over 95 years [95+]) living in Arakawa Ward, Tokyo. We assessed their life satisfaction using the Satisfaction with Life Scale (SWLS), developmental stages of the elderly (Erikson's 8th and 9th stages, i.e., ego integrity and gerotranscendence), and the big five personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism) using NEO Five-Factor Inventory. Multiple regression analyses were performed to examine the relationship between SWLS scores and each assessment, controlling for age, sex, education, activities of daily living (ADL), instrumental ADL, depressive symptoms, and cognitive function. Results: A total of 247 oldest-old people (85+, 229; 95+, 18) completed the surveys. The SWLS scores of 85+ were positively correlated with scores of ego integrity, extraversion, and conscientiousness. In contrast, the SWLS scores of 95+ were positively correlated with gerotranscendence scores. Conclusions: This cross-sectional study identified the psychological characteristics associated with the level of life satisfaction in community-dwelling oldest-old people. A causal relationship between each factor and life satisfaction could not be established. However, it was found that ego integrity, extraversion, conscientiousness, and gerotranscendence may help the oldest-old to elevate life satisfaction and improve their mental health. Further, as the factors associated with life satisfaction in 85+ and 95+ varied, it may indicate differences in the maturation process of life satisfaction in oldest-old people.
| Starting Treatment with or Switching between Two Oral Formulations of Olanzapine in Patients with Schizophrenia and Bipolar Disorder | | |
Hardik Gandhi
Cadila Healthcare Ltd.
E-mail: [email protected]
Abstract
Background: The oral formulations of olanzapine, standard oral tablets (SOTs) and orally disintegrating tablets (ODTs) are similar in pharmacokinetic aspects and bioequivalence. Few studies have reported lower rates of hospitalization and relapse in patients treated with olanzapine ODT as compared to SOT with patient preferences reported to be in favor of the ODT formulation. Despite these similarities and differences, it is not clear which factors drive the choice of formulation among physicians. Objective: This study was conducted with an aim to determine factors driving physician preferences for the two oral formulations of olanzapine. Methods: This study was conducted in the form of an online cross-sectional survey. Results: The survey was attended by 238 unique participants. For a patient presenting with good insight, 94.6% of participants responded that they would begin treatment with SOT. 92.9% of respondents agreed that if a patient has a lower score on the Drug Attitude Inventory, they would prefer to switch the patient to an ODT formulation. Majority of the respondents (57.7%) chose to initiate olanzapine ODT in young patients presenting with an acute episode of schizophrenia. One-third of the respondents (32.7%) preferred to initiate olanzapine ODT in patients presenting with predominantly negative symptoms. Eight-nine percent of participants agreed that they would switch treatment if the patient demonstrated weight gain, had a history of noncompliance to antipsychotic medication or developed swallowing difficulties. Conclusion: The choice of olanzapine formulation (SOT or ODT) for starting treatment in a patient with schizophrenia or bipolar disease is influenced strongly by the patient profile.
| Impact of Mindfulness Meditation on Perceived Stress Levels and Subjective Well-Being among Housewives: A Review | | |
Manpreet Kaur
Chitkara University, Patiala, Punjab, India
E-mail: [email protected]
Abstract
Mindfulness meditation includes when an individual concentrates on his or her breathing pattern with openness and curiosity. Mindfulness if practice regularly can help in better experiences. This review aimed to identify the impact of mindfulness meditation on the different sections of the society. A systematic search strategy was conducted through online databases – Medline, PubMed, SCOPUS, Google Scholar, and Cochrane Library. The literature published from 2007 to 2020 was reviewed. More than 50 papers published related to this area were reviewed. It was found that people deal with plenty of psychological problems related to stress, burnout, and fatigue. Mindfulness helps them in having more awareness regarding their inner as compared to their outer and that would captivate their performance in every aspect. Many studies show that evidence-based implementation plan contributes to the psychological well-being of students. Conclusion: Mindfulness interventions were found very useful for reducing the psychological distress. Further implications include the MBSR (mindfulness-based stress reduction) potentially beneficial for oncology nursing intervention as they are exposed to more stressful conditions. Psychotherapeutic use of meditation technique can be implicated for self-control and relaxation in facilitating personal and spiritual growth.
| Prevalence of Sexual Dysfunction in Patients Receiving Clozapine | | |
Rika Rijal, Sandeep Grover, Subho Chakrabarti, Swapnajeet Sahoo
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Although studies are available on prevalence of sexual dysfunction in patients receiving antipsychotics, data on incidence and prevalence of sexual dysfunction in patients receiving clozapine are limited. Aim: To evaluate the prevalence of sexual dysfunction in patients receiving clozapine. Methods: One hundred and thirty-six patients diagnosed with schizophrenia receiving clozapine for at least 1 year were evaluated for the prevalence of sexual dysfunction using the Arizona Sexual Experience Scale (ASEX). Results: The mean age of study participants was 36.2 (standard deviation [SD]: 10.4) years, and the mean duration of education was 12.7 (SD: 3.1) years. About two-third of the participants were male (64%) and nearly half of them were married (53.6%). On ASEX, 64.7% had sexual dysfunction. When the dysfunction was evaluated in specific domains with an item-wise cutoff of 4, 68% had reduced sexual drive, 66% had difficulty in arousal, 64% had difficulty in reaching orgasm, 64% had poor satisfaction with orgasm, and 60% had problem in erection or vagina getting moist during the sexual activity. There was no significant difference in prevalence of sexual dysfunction between males and females and those who were currently married and currently single. Conclusion: Sexual dysfunction is highly prevalent in patients receiving clozapine. Hence, such patients should be evaluated for sexual dysfunction from time to time and the same must be addressed.
| A Case of COVID-Related Psychosis with Atypical Presentation of Near-Death Experience | | |
Pooja Shakya, Upasna Gopalkrishnan, Pratap Sharan
Department of Psychiatry, AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Introduction: Psychiatric comorbidities such as posttraumatic stress disorder, insomnia, anxiety, and depression are commonly reported among COVID-19-infected patients. COVID-related psychosis has been a neuropsychiatric complication of the infection; however, its mechanisms are under investigation. We report a case of COVID-related psychosis with atypical presentation of near-death experience (NDE). Case: A 43-year-old married man came to our post-COVID outpatient department after 1.5 months of recovery from severe COVID-19 infection. A routine psychiatric assessment done as a part of follow-up did not reveal any symptoms of depression, anxiety, posttraumatic stress, or insomnia. Mini-Cog assessment did not suggest cognitive problems. The client narrated his experience during the 15 days of ICU stay during the COVID infection. He had a psychiatric illness of abrupt onset comprising somatic hallucinations with secondary delusions of persecution, visual hallucinations of seeing his own self (autoscopy), and complex visual hallucinations. These symptoms coincided with derangements in laboratory parameters (raised levels of D-dimer, interleukin-6, lactate dehydrogenase, total leukocyte count, and ferritin). There was no evidence suggestive of fluctuating consciousness, agitation, uncooperativeness, incoherence, and disorientation to place and person based on medical charts of relative reports, thus ruling out the possibility of obvious delirium. During this period, he did not receive any antipsychotics, but he was prescribed benzodiazepines occasionally for sedation. The patient's experience of autoscopy (NDE) was atypical. He felt that his soul was detached from his body, and he (identified with his body) could see and talk to his soul in the external space. During this experience, he had flashbacks of past life events, heard the voice of his soul calling him, perceived that everything was occurring in slow motion, and felt that he is about to die soon. His symptoms remitted over 15 days, while he recovered from the COVID infection (his laboratory parameters also returned to normal within this period). Discussion: The report discusses issues related to an unusual case COVID psychosis with atypical presentation of NDE.
| “The Untold Story” of Rural Women in COVID-19 Pandemic: Intimate Partner Violence and Mental Health | | |
Rahul Chakarvarty
PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Intimate partner violence (IPV) has a tremendous effect on the mental health of a female. This phenomenon is least studied among the rural women, not looked during COVID-19 pandemic. Aim and Objective: To assess the prevalence and association of different types of IPV and psychiatric disorders among married women in a rural area. Materials and Methodology: It was a cross-sectional study with purposive sampling technique. One hundred and sixty-nine participants were assessed on IPV Questionnaire, Generalized Anxiety Disorder Questionnaire-7 (GAD-7), and Patient Health Questionnaire (PHQ)-9. Results: The prevalence of lifetime experience of IPV among the participants was 29.0%. On IPV, controlling behavior was most common, followed by physical violence and threatening behavior, and the least common was sexual behavior. Twenty-six percent had depression on PHQ-9, and 30.8% had an anxiety disorder on GAD-7. The mean score of PHQ-9 and GAD-7 had a significant positive correlation with IPV and its all domains. Those participants whose husbands were consuming alcohol or any other illicit drugs, were from lower socioeconomic status, and reported a significantly higher experience of IPV. Those experiencing violence were significantly more frequently diagnosed with a depressive disorder and anxiety disorder. Conclusion: Women from rural area are at a great risk of IPV. Hence, all the stakeholders such as community health organizations, ministry of family and health-care organization or other government organization, and professional bodies in a coordinated and planned manner can take a pivotal role in research, prevention, or early identification of IPV and psychiatric problems.
| Obsessive Slowness Masquerading as Catatonia – A Case Report | | |
Lalji Verma
VMMC and Safdarjung Hospital, New Delhi, India
E-mail: [email protected]
Abstract
Background: Obsessive slowness is generally described to be a syndrome of extreme slowness in ways various tasks are being performed. Patients with extreme slowness are often misdiagnosed as catatonia, which results in delayed treatment and poor prognosis. The indexed case is being presented with an intention to highlight the clinical differentiating features of catatonia and obsessive slowness. Methodology: We hereby present the case of a 34-year-old female, who presented in the Adult Psychiatry Outpatient Department, Safdarjung Hospital, New Delhi, with chief complaints of sitting in one position for hours, spending more than 1 h in eating and bathing for the last 3 months. Detailed historical evaluation revealed muttering to self, staring on walls for hours, and sitting on bed for hours with folded hands. The patient was diagnosed as catatonia by previous psychiatrists and was put on tablet lorazepam 12–14 mg per day in divided doses with nil response. Results: A detailed neuropsychological assessment was done and repeated mental status examination revealed repetitive ritualistic acts and magical thinking. Diagnosis was revised to OCD (Primary Obsessive Slowness) and was started on tablet fluoxetine 20 mg which was gradually titrated to 80 mg per day and tablet risperidone 2 mg per day. The patient was admitted for 1 month and the patient showed more than 50% improvement in Clinical Global Impression Scale. Conclusion: The aim of this presentation is to highlight the clinical differentiating features and diagnostic difficulties we face in diagnosing obsessive slowness. The possibility of obsessive slowness should always be taken into consideration if catatonic symptoms are not responding to standard treatment. Primary obsessive slowness is an extremely rare clinical syndrome with severe disabling motor performance. Its existence as an independent syndrome is challenged by the authors, who regard it to be a part of obsessive–compulsive disorder.
| Role of Electroconvulsive Therapy in Acute Management of Delirious Mania in a Coronavirus Disease (COVID-19)-Positive Pregnant Female: A Case Report | | |
Anjali Bhasin, Romil Saini, Rohit Verma, T Srinivas Rajkumar, Upasna Gopalakrishnan, Rajan Mishra
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: Delirious mania has been described as an unusual syndrome of acute excitement, fluctuating sensorium, and affective symptoms along with signs and symptoms of catatonia. The current literature evidence exists mainly as case reports and electroconvulsive therapy (ECT) reported as an effective treatment modality. Here, we report a case of pregnant female with features of acute agitation, confusion, and mania. Case Description: A 27-year-old female with 24-week pregnancy presented with 3-week history of acute agitation, insomnia, increased energy, disorganized behavior, irrelevant talking grandeur ideations, diminished self-care, periods of confusion, and nongoal-directed activities showing no response to trial 2 antipsychotics. Examination showed combativeness, disorientation, inappropriate smiling, irrelevant, incoherent, nongoal-directed pressured speech with echolalia, echopraxia, verbal/motor stereotypy, and automatic obedience requiring physical restraint and repeated injectable haloperidol. Organic causes were ruled out following normal routine investigations. Baseline assessment included Brief Psychiatric Rating Scale (BPRS) – 59, Young Mania Rating Scale (YMRS) – 41, Bush-Francis Catatonia Rating Scale (BFCRS) – 15. A working diagnosis of delirious mania was made and ECT was planned three times a week with no change in ongoing oral antipsychotic. The patient tested positive for COVID-19, though asymptomatic, after the first ECT and shifted to COVID-19 isolation ward. Subsequent ECT sessions continued in COVID-19 operation theater under supervision of consultant Anesthesia, Obstetrics and Gynecology, and Neonatology. None of the ECT sessions had any major adverse event. Improvement was noted in presenting symptoms 3rd ECT onward and complete remission after total five ECT sessions (YMRS – 5, BPRS – 27, and BFCRS – 0). The patient was transferred back to psychiatry ward following COVID-19-negative test. Symptom remission was sustained even following ECT discontinuation. Following an uneventful delivery at 35-week gestation with no neonatal adverse effects, both mother and child continued to maintain well in follow-up period on oral olanzapine. Discussion: An unusual case presentation of delirious mania during pregnancy its acute management with ECT in background of COVID-19-positive status highlights the role of interdisciplinary comprehensive patient care for favorable outcomes.
| Thought Stopping as a Part of Exposure and Response Prevention Treatment for “Pure Obsessions:” A Case Study Extended Report | | |
Ankit Kumar Sinha, Subho Chakrabarti
Department of Psychiatry, PGIMER, Chandigarh, India
E-mail: [email protected]
Abstract
Background: The technique of thought stopping is no longer used to treat obsessive–compulsive disorder (OCD) because of concerns about its ineffectiveness and the detrimental effects of thought suppression. However, when used as a part of exposure and response prevention (ERP) treatment, it can still be effective, particularly in those with predominant obsessions without overt compulsions. Aim: The case of a woman with long-standing obsessive thoughts and images and frequent use of neutralizing rituals who benefitted from a combination of thought stopping and ERP is presented. Methods: Standard techniques were used for both treatment strategies based on an ascending hierarchy of anxiety-provoking situations and thoughts. However, cognitive restructuring was replaced by discussions of treatment procedures, evolving means to identify and refrain from neutralizing rituals, and using more adaptive means of coping with obsessional symptoms. Results: Over 3 months of treatment, there were improvements in all aspects of OCD including symptoms, intrusiveness and distress accompanying obsessions, the frequency of neutralizing acts, and the patient's satisfaction and motivation. This improvement has been maintained over more than 2 years of follow-up. Conclusion: It is proposed that the initial exposure to situations or distressing thoughts allowed habituation to occur, whereas thought stopping following exposure acted as a means of response prevention by blocking the neutralizing rituals that prevent habituation. Since thought stopping is a simple technique, its combination with ERP might be useful in patients with “pure obsessions” who have difficulty with the more elaborate procedure of cognitive restructuring.
| Section 100, Mental Healthcare Act 2017: The Cornerstone for Rehabilitation of Homeless Persons with Mental Illness in India | | |
Shivali Aggarwal
E-mail: [email protected]
Abstract
Background: Rehabilitation services in India, especially for homeless persons with mental illness (MI), are in a poor state of being. These services are even worse when it comes to the plight of homeless females with MI. Mental Healthcare Act (MHA) 2017, which has replaced MHA 1987, is a patient's rights-based act focusing on the community living of the persons with MI. To achieve this aim, this act defined the duties of police personnel for the first time with respect to persons with MI in section 100. Objectives: To highlight the role of the police helping in the rehabilitation of homeless females with MI. Methods/Case Summary: A 22-year-old-female, talking irrelevantly and excessively, was found on the streets and brought to the hospital by police (sec 100[1],[3]). The patient was admitted because of the potential risk of harm to others and damage to property. On assessment, she was diagnosed with mania with psychotic symptoms and started on psychotropics, after which she improved. She told her address details which were further confirmed from her biometric details (AADHAR card) by the investigating officer (IO). As she was from another state, the station house officer of the police station from where the patient belonged was contacted by the IO (sec 100[7]). The patient was subsequently shifted to her home by the concerned IO and thereby restoring her family. On follow-ups, her family was psychoeducated and she is maintaining well. Results: Rehabilitation helps in reintegrating patients into mainstream society and improving their quality of life. In this case with the involvement of police, the patient found on the streets was brought to the hospital, engaged in a treatment net, and furthermore rehabilitated in the community setting. Conclusion: In MHA 2017, the role of police personnel is more clearly defined in section 100 that guides them to work in collaboration with the treating team and help in the patient's overall well-being.
| Human Rights and Adherence to Treatment in Patients with Severe Mental Illness: Mental Healthcare Act 2017 Perspective | | |
Ira Domun
GMCH, Chandigarh, India
E-mail: [email protected]
Abstract
Background: Mental Healthcare Act (MHCA) has been implemented on May 29, 2018. Patients with mental illness show high rates of medication nonadherence as well as human rights violation. Hence, it is important to study the impact of this new law on care of persons with mental illnesses and the human rights awareness with emphasis on the two modes of admissions, i.e., Supported and independent. Aim: Influence of MHCA 2017 on patients with severe mental illness (SMI) admitted undersupported and independent category and its correlation with adherence to treatment and human rights of PMI. Methodology: Patients diagnosed with SMI (NIMH) were admitted in psychiatry ward. Baseline sociodemographic, psychopathology severity, global functioning, adherence rates, insight, and human rights awareness were assessed. Patients were grouped into independent and supported groups. Weekly assessments were done during admission and subsequent assessments were done post discharge at week 1 and week 6. Results: A total of 65 were included. Emotional needs dimension of human rights showed P < 0.01 at baseline as well as final follow-up. A statistically significant correlation was seen in human rights awareness and adherence at baseline in independent admission group (IAG). Brief Psychiatric Rating Scale score at baseline is higher (46.82 ± 11.90 and 48.85 ± 14.92) and MARS score and CRS score were lower (4.29 ± 2.13; 4.06 ± 1.73, and 3.38 ± 1.98; 3.26 ± 1.91) in supported admission group (SAG). The insight as assessed on Schedule for Assessment of Insight-Extended version showed a statistically significantly higher value in IAG (12.80 ± 7.26 and 8.18 ± 6.96) at baseline. Findings on these scales have shown progressive improvement in adherence and insight, however, subsequently, the differences remained statistically nonsignificant. Conclusion: No significant difference could be seen in illness specifiers and adherence patterns between the two groups. Findings reflect statistically lower fulfillment of emotional needs in SAG and positive correlation between medication adherence and human rights awareness. Therefore, adherence is an important determinant of human rights awareness.
| Award Posters | | |
| Longitudinal Assessment of Disability amongst Patients of Bipolar and Unipolar Depressive Disorders Presenting to a Tertiary Care Center in North India | | |
Mahadev Singh Sen, Rajesh Sagar, Nand Kumar, Nishtha Chawla
AIIMS, New Delhi, India
E-mail: maha[email protected]
Abstract
Background: Disability in psychiatric illnesses may increase or decrease over time based on the nature of illness. Limited literature is available on longitudinal assessment of disability across various psychiatric disorders. Objectives: The present study aimed to assess and compare the changes in disability scores associated with bipolar depression (BD) and unipolar depression (UD) over 1 year. Methods: A longitudinal study was taken up in the outpatient department of a tertiary care center. Individuals diagnosed with unipolar or bipolar depressive disorder with current depressive episode, aged 18 years and above, belonging to either gender were recruited. Diagnosis was made according to Schedules for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton's Depression (HAM-D) rating scale and Hamilton's Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London Handicap Scale (LHS). Results: Sixty participants were recruited (42 – UD and 18 – BD). No significant differences were seen in sociodemographic parameters, except higher education levels and males being overrepresented in UD group. Significant differences at baseline were seen in HAM-D (P = 0.001) and HAM-A (P = 0.003) scores. The extent of disability was seen to correlate with severity of illness only in the case of bipolar disorder at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment (P < 0.001). LHS showed significant improvement over time in UD group (40%), were comparable at baseline but were significantly more in the BD group at 12 months (P = 0.049). Conclusion: Disability in psychiatry occurs equally among unipolar and bipolar depressive disorders and tends to improve over time. It may not always correlate with the cross-sectional severity of illness. The level of improvement in UD and BD may differ.
| Psychiatric and Substance Use Comorbidities among People Who Inject Drugs in India: A Cross-Sectional, Community-Based Study | | |
Romil Saini, Arpit Parmar, Ravindra Rao, Ashwani Kumar Mishra, Atul Ambekar, Alok Agrawal
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background: People who inject drugs (PWID) show higher rates of comorbid psychiatric illnesses than the general population. Objective: We aimed to assess the rates of different psychiatric disorders and substance dependence among PWID in the state of Delhi, India. Methods: We conducted a community-based, cross-sectional study interviewing 104 adult male participants receiving various harm reduction and HIV prevention services. A semi-structured questionnaire assessed sociodemographics, drug use and injecting pattern, and opioid overdose experience. Mini-International Neuropsychiatric Interview version 7.0.2 (for screening and diagnosing major psychiatric disorders) and World Health Organization-Alcohol, Smoking, and Substance Involvement Screening Test for the pattern of other psychoactive substance use were also used. Results: The mean age of participants was 27.9 years. About 54% were unmarried, 51.9% unemployed, and 83.7% were residing in an urban slum area. The predominant opioid injected in the last 1 year was heroin. About 52% of participants had at least one psychiatric illness during their lifetime. Antisocial personality disorder (25%) was the most common psychiatric illness followed by suicidality (23.1%). About 23.1% had more than one psychiatric comorbidity other than substance use disorder. Being unskilled (χ2 = 11.39; P = 0.03), having early mean age of tobacco onset (t = −2.416; P = 0.02), longer duration of tobacco (t = 2.033; P = 0.04), alcohol (t = 2.204; P = 0.03) use, less abstinent attempts for opioid use (χ2 = 5.003; P = 0.03), longer duration of injecting drug use (t-test = 2.437; P = 0.02), high HIV positivity rate (χ2 = 8.54; P = 0.01), and high rates of nonfatal opioid overdose over lifetime (χ2 = 4.87; P = 0.03) were significantly associated with having lifetime psychiatric illness. Conclusion: Our study highlights the need for incorporating mental health services into the existing HIV prevention services directed at PWID in India.
| A Cross-Sectional Study of Characteristics, Patterns, and Effects of Cannabis Use during COVID-19 Pandemic in Delhi, India | | |
Nileswar Das, Roshan Bhad, Ravindra Rao
AIIMS, New Delhi, India
E-mail: [email protected]
Abstract
Background and Objective: COVID-19 pandemic has affected every aspect of human life. The worst hits are those with prior comorbidities. Individuals with substance use disorder (SUD) are likely to be affected both due to higher susceptibility and disturbed clinical care for SUD (e.g., opioid agonist treatment). Cannabis use has been postulated to have a complex relationship with COVID-19 illness. This study was planned to explore the effect of COVID-19 and related lockdown on cannabis use among help-seeking individuals in an urban community. Methods: It was a cross-sectional, exploratory study among individuals with cannabis use disorder-seeking help from a community clinic in Delhi for opioid dependence, during the first wave of the pandemic in India (July–December 2020). Participants were interviewed about their cannabis use pattern, COVID-19 symptoms, perceived stress (PSS-10), and coping (Brief-COPE-28). Statistical analysis was done using MS Excel and SPSS v.21. Results: Out of 105, 100 (95.2%) participants were included as per selection criteria. All participants were male with a mean age of 25.2 (±5.9) years. More than half (52%) of the participants have perceived changes in their cannabis use pattern since the COVID-19 outbreak. The average amount of cannabis consumed during the lockdown months was significantly lesser (t = 7.3, df = 98, P < 0.001) than prior to lockdown. However, there was no significant difference (P = 0.2) in cannabis consumption between lockdown months and the months of unlocking. The mean PSS-10 score was 16.0 (±4.6), with the majority (66%) having “moderate stress.” Approach coping was the predominant type of coping. Conclusions: Cannabis consumption was reduced during the COVID-related lockdown and remained lower than the prelockdown use among treatment-seeking individuals with SUD. Participants experienced moderate stress and used approach coping to adjust with the stress.
| COVID-19-Related Knowledge, Attitude, and Practices among Persons with Mental Illness | | |
Isha Batra, Aparna Goyal, Shipra Singh, Sidharth Arya, Purushottam Jangid, Abhishek Kumar, Jagriti Yadav
PGIMS, Rohtak, Haryana, India
E-mail: [email protected]
Abstract
Introduction: Novel COVID-19 virus was declared as a pandemic and brought unprecedented changes globally. The only way forward was to embrace precautions and preventive strategies to combat this virus. People with mental illness are at higher risk not only because of their increased vulnerability to get infected due to a decreased sensitivity to threats, cognitive impairment, little awareness of risk of getting infected or becoming a source of infection along with limited awareness, and intent to access health resources. Adequate knowledge with positive attitude and good practices will lead to an effective intervention in battling this pandemic and their levels need to be assessed so as to ascertain their safety from this global catastrophe. Objective: To assess the knowledge, attitude, and practices (KAP) toward COVID-19 in patients with mental illnesses. Methods: A cross-sectional study was conducted on patients with Global Assessment of Functioning score of more than 50 presenting to the Department of Psychiatry, Pt. BD Sharma UHS, Rohtak, aged between 18–60 years for the study. A specially designed pro forma to collect sociodemographic and clinical details along KAP questionnaire related to COVID-19 was completed and analyzed. Results: Three hundred and eighty-five patients were analyzed and mean scores of KAP were found to be 11.05 ± 2.39 SD, 5.64 ± 1.54, and 5.98 ± 1.54, respectively, indicating fair knowledge, positive attitude, and good practices among our target population. Better education, employment, and urban locality were associated with better KAP among our subjects. Conclusion: Good KAP helps in increasing implementation of effective preventive strategies imperative for safety of self and others in this global crisis. Patients with mental illness are a vulnerable subset and need more care and awareness regarding COVID-19.
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