Indian Journal of Psychiatry

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ISSN / EISSN : 0019-5545 / 1998-3794
Published by: Medknow (10.4103)
Total articles ≅ 4,081
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, Sriharsha Kadiveti, Bhavika Vajawat, PrakyathR Hegde, Sydney Moirangthem, SureshBada Math
Published: 1 January 2022
Abstract:
Background: Legislative backing exists to set up free legal aid clinics in psychiatric hospitals to provide legal assistance to their patients. Aims: This study aimed to assess the utility of a free legal aid clinic running inside a mental health establishment. Methods: In this prospective study, 71 subjects (chosen via convenience sampling) were recruited. Assessments were carried out at baseline and two months after intake. Legal needs and the legal outcomes were assessed. Results: Most of the legal issues were either family-related (50.7%) or civil issues (28.2%). A majority of patients (64.4%) had implemented the advice given at the clinic. Those who had implemented the advice had a better legal outcome, defined as either resolution of the legal issue or that the legal issue was in an active proceeding compared to those who had not implemented the advice (P = 0.007). Conclusion: The provision of free legal aid services in mental health establishments would benefit patients.
, Vikas Menon
Published: 1 January 2022
Abstract:
Competency-based medical education curriculum (CBME) has received traction worldwide. However, its adoption and implementation have significantly varied across the globe. The National Medical Commission, India (2019) has adopted CBME to improve the quality and content of training of medical students. However, the ongoing COVID-19 pandemic has spawned several challenges implementing the CBME. Therefore, there is a need to reflect on using novel teaching and assessment methods to enrich medical and psychiatric training. In this paper, we aimed to study global trends and characteristics of competency-based psychiatry training programs and how these experiences can be utilized to overcome challenges and facilitate the implementation of CBME in Psychiatry in the Indian context. A literature search was conducted using PubMed and Google Scholar databases. The findings are presented narratively. Psychiatry training for medical students greatly vary across the globe. High-income countries mainly have implemented CBME and have incorporated psychiatry training during the foundation/pre-clerkship period itself. There is more reliance on skill development and flexible and learning-based training vs. time-based training. Various enrichment activities have been incorporated into the medical curriculum to promote and strengthen psychiatry training for medical students, particularly in developed nations, which have yielded positive results. Although the COVID-19 pandemic has adversely affected the medical student’s training, it has reiterated the significance of skill-based education and opened novel avenues for implementing the CBME.Medical educationists need to adapt themselves to provide CBME to the students. Making structural, curricular changes, orienting teachers, and students about the CBME, mentoring teachers, adopting novel training and assessment methods, utilizing enrichment activities, collaborating with educational institutions and technology providers, periodically evaluating the implementation of the CBME, and making appropriate course corrections are essential. In addition, there is a need to address structural barriers, such as lack of workforce, for better realization of the CBME objectives.eriodically evaluating the implementation of the CBME, and making appropriate course corrections are essential. Additionally, there is a need to address structural barriers, such as lack of workforce, for better realization of the CBME objectives.
, Preethy Kathiresan, Kamini Verma, Ravindra Rao, Raka Jain
Published: 1 January 2022
Abstract:
Background Chronic opioid use affects biological functioning implicating the hematopoietic and immune system. It may alter various hematological parameters and inflammatory markers. This study aimed to assess the association of opioid dependence with the hematological parameters and inflammatory markers in the Indian population. Methods A retrospective chart review was done among opioid dependent (ODS) males and healthy controls (HC) who visited the center’s laboratory between Jan 2017 and Dec 2018 for hematological investigations. Clinical records reviewed for opioid use details like type, duration, and route of administration. The hematological profile presented as Mean or median. Mann–Whitney U test was used to compare the hematological parameters between the cases and controls. Results The study included 191 ODS patients and 123 controls. Among ODS patients, a significant decrease in the levels of hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin and an increase in RBC count and lymphocytes was observed when compared to controls. The inflammatory markers, Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio, were significantly lower among ODS. Longer duration of opioid use leads to increased NLR among ODS patients. Opioid use by injection did not alter any of the hematological parameters compared to non-injection drug use. Conclusion Chronic opioid use has a significant effect on the hematopoietic cells. Opioid use for longer durations increases the inflammatory markers suggesting underlying infections.
Published: 1 January 2022
Abstract:
Background: Recent studies suggest five domains for negative schizophrenia symptoms: anhedonia, asociality, avolition, blunted affect, and alogia. Avolition has been considered a characteristic symptom in community-dwelling patients. However, few studies have explored the association of these symptoms with long-term hospitalization. Purpose: This study explored the relative association of each of the five domains of negative symptoms in two groups of patients with schizophrenia: long-term hospitalized and community-dwelling patients. Methods: Participants included 56 long-term inpatients and 111 community-dwelling patients at Nasukougen Hospital in Japan. The nearest neighbor matching within caliper was used. After matching participants by age, sex, disease duration, and years of education, each group was assigned 30 participants. Model 1 was analyzed with a logistic regression analysis with 5 subdomains as independent variables. Model 2 was analyzed after adding positive symptoms, cognitive function, functional skills, and functional outcomes to the subdomains that were significant in model 1. Results: The results indicated that asociality was significantly associated with long-term hospitalization. When the characteristic clinical factors of schizophrenia were added, asociality, daily living skills, and social and role functions were found to be characteristic of long-term hospitalization. Among the negative symptoms, lack of social motivation was more characteristic among the group with a poor prognosis. Conclusions: Of the negative symptoms associated with long-term hospitalization, asociality, lack of social motivation, rather than avolition was found to be most strongly associated with community-dwelling patients’ functional outcomes. Further studies are required to establish a causal association as it may have therapeutic implications.
, Marilúroxana Soto-Vásquez, Luisenrique Rosales-Cerquín
Published: 1 January 2022
Abstract:
Background: As the COVID-19 pandemic progresses, mental health begins to be affected. In this sense, practical and low-cost solutions are necessary to minimize the impact on the population. Aim: This study aimed to determine the effect of a mindfulness-based online intervention for mental health during times of COVID-19. Method: A quasi-experimental study was carried out with pre-test and post-test measurements in a sample of 62 participants divided into an experimental group whose members were administered a 12-session mindfulness online program, and a control group on the waiting list. The Zung Self-Rating Anxiety Scale (SAS) was used to assess anxiety, the Zung Self-Rating Depression Scale (SDS) to measure depression, and the Perceived Stress Scale (PSS-14) to determine stress levels. Results: The levels of anxiety, depression, and stress decreased after the intervention, finding significant differences between the groups and study phases (P < 0.05). In addition, moderate changes in anxiety (d = 0.849, g = 0.847) and depression (d = 0.533, g = 0.530) were found, as well as important changes in stress reduction (d = 1.254, g = 1.240). Conclusion: There is evidence of a potential for the use of mindfulness program to reduce stress, anxiety, and depressive symptoms in stressful situations such as the COVID-19 pandemic.
, Nishant Goyal, Sandeep Grover, Ranjan Bhattacharyya, Vikas Menon, Debadatta Mohapatra, Aseem Mehra, Ajaykumar Bakhla
Published: 1 January 2022
Abstract:
Background: Behavioral and psychological symptoms (BPS) are usually the expected consequences of dementia. BPS increases morbidity and burden, affects the quality of life, and impacts care costs. However, the symptom characteristics, clinical correlations, and symptom-specific clusters aiding the diagnosis are less well studied, especially in the Indian population. Materials and Methods: The present study examined the BPS clusters based on various cognitive and neuropsychiatric profiles in patients with dementia under a multicentric study in India. We did a cross-sectional assessment using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and cognitive functions by Montreal Cognitive Assessment (MoCA), and the severity of dementia using the Clinical Dementia Rating (CDR) scale. In addition, all of the participants were evaluated on a structured Clinical Interview for DSM-5 Research Version for past or current psychiatric disorder(s). Results: We describe the various BPS clusters uniquely associated with the severity of dementia. Further, on linear regression analysis, we predicted three symptom clusters (anxiety, irritability, aberrant motor) in mild, two symptom clusters (disinhibition, agitation/aggression) in moderate and three symptom clusters (delusion, euphoria/elation, disinhibition) in severe dementia. Conclusion: The study provides insights into the various symptom characteristics and inter-relationship of BPS, which may benefit the clinician while assessing patients with dementia.
, RakeshKumar Chadda, Nishtha Chawla, MonaR Sharma, Rekha Patel, Mohapradeep Mohan, Srividya Iyer, R Padmavati, Rangaswamy Thara, SwaranP Singh
Published: 1 January 2022
Abstract:
Background: We aimed to understand the needs of service users – families and patients with schizophrenia and related disorders, and mental health professionals (MHPs) and expectations from a home-based psychosocial intervention program in Indian setting. Materials and Methods: We conducted four focus group discussions (FGDs) with families, patients with schizophrenia and related disorders and MHPs. Two FGDs were conducted with families and one each with the patients and MHPs. Participants in families and MHP group were asked about their primary concerns in caring for the patients, perceived needs of patients and the areas that can be targeted through a home-based psychosocial intervention program. All FGDs were audio-recorded and verbatim transcribed. Content analysis of the data was done to obtain a final list of needs and expected outcomes from a psychosocial intervention supported by families. Results: Six key priority needs were identified for intervention: medication adherence, activities of daily living, promoting physical health, engagement in meaningful work, building of social and support networks and information about all aspects of illness. Priority outcomes identified by MHPs were mostly clinical like symptom reduction, fewer rehospitalisation while families and patients focused more on psychosocial outcomes, such as improvement of wellbeing, having relationships, engagement in meaningful activities, better organization of the day, increased self-respect, reduced stress, lesser interference, and critical comments. All groups suggested that book or mobile app or video could be used. Conclusion: This qualitative study shows that while both clinicians and service users consider recovery from schizophrenia and related disorders to be important, they differ on what they prioritise.
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