Psychiatry In India Research Articles

Dr Nagendra Nath De

Dr Nagendra Nath De is an important figure in the history of Indian Psychiatry though little is known about him. Even before reading this article I am sure many of us only knew a single phrase ‘first editor’ of Indian Journal of Psychiatry’ about him. I have tried to highlight many untold contributions of Dr De.

Editorial

In this special issue, we have tried to highlight the contributions of the ‘Luminaries of Bengal Psychiatry’ whose efforts over the years has brought Indian Psychiatry to what it is today. The current generation has a tendency to look for all achievers and achievements beyond their own place. With passing time, the contributions of these individuals are likely to be forgotten. Hence, it is our responsibility to highlight the achievements of these great souls whose legacy is being carried on today in various aspects - teaching, academic writing, clinical work or community services. I am really indebted to the contributors who have toiled very hard in such a short period of time to make this special issue see the light of the day!

What they think of us: A study of teaching medical specialists' attitude towards psychiatry in India.

Context:Attitudes of teaching medical specialists are important in shaping medical students’ attitudes toward psychiatry. Data on attitudes of teaching medical specialists of India toward psychiatry are limited.Aims:The aim was to study the attitude of teaching medical specialists of an academic medical center in East India toward psychiatry.Settings and Design:This was a cross-sectional descriptive study.Materials and Methods:We administered attitude toward psychiatry-30 (ATP 30) scale to teaching medical specialists of the All India Institute of Medical Sciences, Bhubaneswar, based on convenience sampling. Of 104 specialists contacted, 88 returned the completed questionnaire.Statistical Analysis:We carried out descriptive statistical analysis and expressed results in mean and standard deviation. We analyzed the association of demographic characteristics, specialization, and duration of professional experience with total ATP scores using Chi-square test. We used subgroup analysis to compare mean ATP scores in different demographic and professional groups. We used independent t-test and ANOVA for between group comparisons.Results:The response rate was 84.62% with a mean ATP score of 88.60. Female gender and having a family member with mental illness was significantly associated with favorable ATP. Notable findings were that 97% of participants were favorable toward patients with psychiatric illness, 90% felt psychiatric interventions as effective whereas 87% found psychiatry unappealing and 52% said that they would not have liked to be a psychiatrist.Conclusions:While favorable attitudes toward patients with psychiatric illness and psychiatric interventions may mean better patient care; unfavorable attitudes toward psychiatry as a career choice may adversely affect postgraduate recruitment rates.

Virtual Patients in Psychiatry: A Study of Mania And Schizophrenia.

This study using computer graphics based Virtual Patients of Mania and Schizophrenia is the first of its kind in Psychiatry in India. In Psychiatry, Virtual patients instead of live patients offer many advantages in cases of violence, suicide, complex phenomenology and where typical cases are few. 104 medical students of Maharajah's Institute of Medical Sciences, Nellimarla, India volunteered to rate the 3min 20 sec animation graphics video portraying Ravi as Mania and George as Schizophrenia using Young Mania Rating Scale (YMRS) and Positive and Negative Symptoms of Schizophrenia (PANSS). 53 students of Fifth Semester in two batches of 28 and 25 were compared with 51 students of Eighth Semester on their scoring patterns. All batches had mean YMRS and PANSS scores above cutoff indicating positive diagnosis but those with at least 5 hour theory exposure prior had significantly higher scores on PANSS and YMRS. The major differences in scoring were on Negative symptoms and YMRS. In conclusion, computer generated 3 d graphic virtual patients are quite effective as teaching tools in psychiatry.

Quality of Life in Chronic Mental Illnesses: Exploring New Frontiers—by Abhishek Pathak, Krishna Prasad Muliyala, Jagadiha Thirthalli, Santosh Kumar Chaturvedi (Editors). NIMHANS Publications, Bengaluru, 2016. 220 pp, 400. ISBN 978-81-8646468-00-5

Psychiatry is gradually expanding its horizons and moving towards a more humanistic treatment approach with quality of life taking over symptom improvement as treatment outcome. While decades have passed since quality of life has been studied in the context of chronic mental illness; researchers continue to debate on its exact definition and conceptualization. It still remains debatable as to what is the core of quality of life: hedonic well being or patient functioning. There are also differing views towards adopting subjective measurement or to include objective measures also while making assessment of quality of life in the context of mental illness. Written by pioneers of rehabilitation psychiatry in India, experts from Psychiatric Rehabilitation Services, NIMHANS this is treatise on quality of life in chronic mental illnesses. Released on the occasion of Workshop on Quality of Life on 30th Jan 2016, this is the first Indian book on this topic. The book systematically captures quality of life research in various mental illnesses. Meant for psychiatrists, psychologists and other mental health professionals, the book gives insight about quality of life as a construct, issues regarding difficulties during assessment, fallacies in measurement and practical suggestions about measuring quality of life across the spectrum of psychiatric diagnoses. The book is set in four sections: the first section discusses the concept of quality of life in mental illness, its determinants and interplay with culture in the Indian context. Second section is on measurement of quality of life in mental illness with discussion of affective fallacy, cognitive fallacy and reality distortion fallacies. The third section addresses measurement of quality of life in various psychiatric disorders. In addition to chronic mental disorders, the authors have made a laudable attempt to describe quality of life in childhood psychiatric disorders and geriatric populations with dementias. My personal favorite is the chapter on quality of life and women mental health. Dr. Chandra is a renowned psychiatrist in the area of women’s mental health and the chapter eloquently captures gender specific determinants of quality of life across psychiatric diagnoses and proceeds to make recommendations for gender specific care for females with psychiatric disorders, very pertinent for the androphilic Indian society. Various interventions and their relation with quality of life have been mentioned in the fourth section. Biological interventions like psychotropics and brain stimulation methods have been addressed in separate chapters and so are psychological and social interventions which improve quality of life in various mental illnesses. Role of art and yoga which are acclaimed the world over for their therapeutic effects in improving quality of life has also been addressed adequately. In the whole process of working towards improving quality of life of patients with mental illness, caregivers and therapists often face burden and experience burnout. The authors have suggested interventions for caregiver quality of life improvement and made recommendations for therapists towards enhancing their own quality of life. Priced at INR 400, the book is value for money and is a must read for trainees in psychiatry as well as psychology. The book would also be extremely useful for clinicians as well as budding researchers in India who work with patients with chronic mental illness. Release of the book heralds a new era in Indian psychiatry that which keeps patient empowerment at its core. & Suravi Patra patrasuravi@gmail.com

Mental health and the law: An overview and need to develop and strengthen the discipline of forensic psychiatry in India.

Human rights and mental health care of vulnerable population need supportive legislations and policies. Both “hard” and “soft” laws relevant to mental health care have been devised internationally and locally. Amendments in laws and the formulation of new laws are often required and have been seen to occur in the area of mental health care in India. So far, reform in mental health care has largely been reactive, but newer legislations and policies carry the hope of proactive reform. The lack of trained human resources is one of the biggest problems in effective mental health care delivery in India. While postgraduate psychiatric guidelines recommend a 2-week training in forensic psychiatry, this is insufficient to develop the necessary competence in the area. There is, thus, a need to develop subspecialty of forensic psychiatry. Forensic psychiatric services also need to be developed, properly structured, and supported. There is a need to set up one or more centers of excellence in forensic psychiatry in India.

Forensic psychiatry in India: Past, present, and future.

Forensic psychiatry is a subspecialty of psychiatry, in which scientific and clinical expertise is applied to legal issues in legal contexts embracing civil, criminal, correctional, or legislative matters. Forensic psychiatry is still in an infant stage in India and other developing countries. Law is the sanctioning discipline, and Psychiatry is the therapeutic discipline. Due to various reasons, Forensic Psychiatry is reared as Cinderella in our country; “which is much neglected, ignored, misinterpreted, and misunderstood. Legislation forms an integral component in the implementation of Mental Health Care; there is a dynamic relationship between the concept of mental illness, treatment of the mentally ill, and the law. Mental Health legislation is essential in protecting the rights and dignity of persons with Mental Disorders and for implementing effectively the mental health services. “Effective mental health legislation can provide a legal frame work to integrate mental health services in the community as to overcome stigma, discrimination, and exclusion of mentally ill persons. Legislations can also create enforceable standards for high quality medical care and improve access to care and protect civil, political, social, and economic rights of the mentally ill individual, including right to access to education, employment, housing, and social security.”

Research on family caregiving for mental illness in India and its impact on clinical practice: Are we doing enough to help families?

Families of Indian patients with mental illnesses have always been involved in their care. Such involvement arises both from choice as well as the compulsion of being a part of an inadequately resourced mental health system. Regardless, families have had to pay a heavy price for undertaking the task of providing care. An extensive body of Indian research on caregiver burden in a number of mental illnesses shows that providing care for a relative with mental illness is associated with considerable distress and burden for the family caregiver. However, much of this research has not made the shift from the somewhat outmoded concept of caregiver burden to the currently prevalent practice of considering the caregiving experience in its totality. Moreover, most of the research is not driven by contemporary theories of caregiving such as the stress coping model. Indian psychiatry has also had a long tradition of supporting family caregivers while they provide care for their ill members. Nevertheless, the Indian evidence for the efficacy of formal family-based interventions remains inadequate and lacks methodological precision. Finally, day-to-day practice in clinical settings does not seem to have made use of the ample body of research evidence in this area to help families in distress. Despite all these problems, progress is being made in the area of family caregiving for mental illness in India. Despite all these problems, slow but steady progress is being made in the area of family caregiving for mental illness in India. It can be hoped that some day in the near future, this progress would translate into mental health professionals forging a true partnership with families providing care for those with mental illnesses.

Task before Indian Psychiatry Today: Commentary.

In this commentary on the article, “The Task Before Psychiatry Today Redux: STSPIR,” (Singh, 2014)[20], the author, while agreeing with most of the paper's findings, proposes a rather parallel judgment that intersects at the same paths ahead. There is a need for widespread and easily available essential mental health services in India. Health agenda must focus on spreading and scaling up psychiatric services. There is also a need to spread awareness of psychiatry and mental health and, as a psychiatrist, one must focus on making psychiatry available to a wider audience. Psychiatrists need to maintain a holistic view of psychiatric disorders while viewing them from both a neurobiological and psychosocial perspective. There is a need to revamp psychiatric training in departments with an increase in the thrust toward fostering translational research excellence in various spheres. Psychiatrists must continue to be trained in psychotherapy and practice it regularly. Psychiatric departments need to promote research excellence and focus on reducing brain drain. The practical applications of the tasks set out for psychiatry are more difficult than one can imagine, and a conscientious effort in that direction shall serve for its betterment. The future is bright and psychiatry must work toward making it brighter.

Undergraduate psychiatry training in India; past, present, and future looking for solutions within constraints!!

Byline: M. Kishor, Mohan. Isaac, M. Ashok, Lakshmi. Pandit, T. Sathyanarayana Rao Psychiatric disorders are considered one of the leading causes of morbidity and mortality worldwide.[sup][1] They are closely associated with other medical conditions such as diabetes and hypertension, adversely affecting their outcome.[sup][2],[3] India has more than 1/6[sup]th of the global population, and is a rapidly developing country with enormous changes in all spheres of life. Mental health issues are gaining a great deal of importance, in keeping with other health issues, and are likely to play a key role in the diverse indicators of development. Suicide rates in India are reportedly one of the highest in the world and have already attracted political and socio-cultural trajectories in both causation and solutions for the problem, underplaying mental health causes for the same, as well as understating the inadequacy of mental health services in India.[sup][4] Concerns regarding the mental health scenario in India are directly related to a lack of awareness among the public and a lack of the minimal mandatory training in psychiatry for medical undergraduates, which has consistently produced thousands of doctors who are incompetent to diagnose and manage common conditions such as depression and suicide.[sup][5] Training undergraduates in the field of psychiatry can be considered as one of the most important pathways to improve mental health services in India. That undergraduate training in psychiatry is inadequate has been the contention from the first report of the subcommittee on undergraduate teaching in psychiatry, Indian Psychiatry Society (1965).[sup][6] The emphasis has been on inadequate hours of training in psychiatry as well as a lack of the required trained staff. Painfully, despite the numerous evidences about benefits of undergraduate psychiatry training [sup][7],[8],[9] nothing seems to have changed in this half of the century (1965–2015) as the Medical Council of India is reluctant to make psychiatry a mandatory subject for the MBBS examination,[sup][10] impairing the mental health component of basic health services in India. This great lacuna in Indian medical education is likely to have an adverse effect on mental health services for the next few decades. In addition is the issue that India has a large deficit of psychiatrists with just 0.3 for 100,000 populations, as mentioned in world mental health atlas 2014.[sup][11] To address this challenge, we may have to look for solutions that enable us to attract medical students to the subject of psychiatry, and build psychiatric knowledge and skill in them through diverse ways. The onus for achieving this lies on each faculty and the department as a team, the policies of the Institution and University to which they belong, as well as professional bodies like the Indian Psychiatric Society, each of whom will have a major role to play. The efforts of Indian Psychiatry Society have been well-summarized by Dr. Roy Abraham Kallivayalil in his presidential address at ANCIPS 2012, Kochi. The Medical Council of India had made it mandatory for all medical colleges to have a department of psychiatry as a part of teaching hospitals, providing mental health services in a general hospital setting. Needless to say, most nonteaching hospitals in India, public or private, do not have psychiatric services on a regular basis. Hence, medical colleges are crucial centers for providing Mental Health Services. Currently, there are 412 medical colleges in India with 52,325 MBBS seats.[sup][12] The onus of training these medical graduates in psychiatry for whom the subject is not mandatory, as in, not assessed in the current examination system, lies with the faculty in psychiatry, they have to use their knowledge and passion in delivering psychiatric training for these students. Departments that have recognized postgraduate seats must also put in the same degree of effort in teaching the undergraduates. …

Non-suicidal self-injury and other self-directed violent behaviors in India: A review of definitions and research.

The interpersonal theory of suicide suggests that most forms of self-directed violent behaviors lie on a continuum, with each behavior successively increasing the capability of committing suicide. There is increasing evidence to suggest that the continuum may begin with Non-Suicidal Self-Injury (NSSI). This theory can be important in developing interventions for suicide prevention. However, in India, consistent usage of definitions of various forms of self-directed violent behaviors is lacking. In the present study, we reviewed definitions of various forms of self-directed violent behaviors that have been investigated in India. Further, we compared the usage of these definitions with the usage by WHO. Additionally, we reviewed NSSI research in India. Thirty-eight publications were identified by a comprehensive electronic search undertaken in Indian psychiatry, psychology, and mental health-related databases. Inconsistent definitions of eight self-directed violent behaviors were observed in Indian literature. Agreement on consistent definitions of various forms of self-directed behaviors is essential. Based on the findings of the current review, it can be suggested that culturally relevant large-scale research on NSSI in India is required to confirm the limited evidence that suggests high prevalence of NSSI in India.

“The Tools of Your Chants and Spells”: Stories of Madwomen and Indian Practical Healing

ABSTRACTA longstanding trope in Indian psychiatry, and in popular representations of it, involves the efficacy of incantations and exorcism in healing afflictions of the mind, notably hysteria. In many accounts, from nineteenth century medical journals to twenty-first century popular films, a medicine deemed at once ‘Western’ and universal is granted the ability to diagnose neurotic afflictions, but rendered incapable of curing them, while bodily techniques referred to as ‘Indian’ are granted efficacy. In this article, I explore the subtleties and implications of this recurrent knowledge paradigm. I argue that a particular arrangement—one in which difference is established through equivalence—undergirds the terms by which medicine comes to be viewed as a cultural encounter. As these progressive formulations are often founded on stories about women’s madness, I ask, what are the implications of an arguably pragmatic ethos founded on an uneven—and deeply gendered—resolution to postcolonial knowledge problems?

Asperger syndrome in India: findings from a case-series with respect to clinical profile and comorbidity.

Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders.

Colonial Psychiatry in Mid-nineteenth Century India

This article is largely based on historical analysis of an overlooked and unexplored colonial document. The Sir James Clark Enquiry of 1868, conducted by the Government of India, contains rich evidence of the mindset of policymakers and those who implemented colonial psychiatry in 14 institutions. While the state regarded the asylum system as burdensome, it made ample efforts to sequester the insane. In view of such ambivalence, the article scrutinises the relationship between colonialism and psychiatry, and also probes some reasons behind the state’s inability to establish superior-quality asylums in India. The findings throw new light on the limited colonial agenda of psychiatry in India, highlighting the basically punitive nature of psychiatric infrastructures, linked with attempts to create an ordered society, but above all to minimise costs.

In India, psychiatry has come a long way.

This Presidential Address of the Bombay Psychiatry Society covers the state of psychiatry in India in 1997. It posits that with the advent of newer brain imaging technologies in India such as computerised tomography, magnetic resonance imaging, single photon emission computerised tomography and brain electrical activity mapping, an era of evidence-based psychiatry in India has arrived. The Address cautions against the dehumanising potential of excessive reliance on technology. The need for a greater emphasis on psychiatry during undergraduate medical education is discussed along with the need to destigmatise psychiatric disorders. Finally, the need to encourage quality research in psychiatric disorders is stressed.

Current challenges in practice of psychiatry in India.

Byline: Vidyadhar. Watve Honorable immediate past President Dr. T.V. Asokan, members of the Executive Committee, all the zonal, state, regional and local branch office bearers of the IPS and above all most revered life fellows, fellows and members of the IPS. On the eve of my presidency, IPS is at its most glorious era. Two of alumni have held or are holding Presidentship of international organizations, an active member is the secretary general of the WPA, four of our members are holding high offices at the WPA and one IPS member has been bestowed with a prestigious international award. First of all I am assuming office when Dr. Asokan with his vision, modesty and skill has led the IPS to a position which makes my task easier for the coming year. I have chosen my topic as current challenges in practice of psychiatry in India because that defines my life of last 38 years as a psychiatrist and as an individual. What better way to describe my expertise and experience than this, which may guide younger colleagues in practice of psychiatry. My Early Days I entered this magnificent branch of medicine as a postgraduate student in 1974 which was the era of Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM II) and International Classification of Diseases 9 (ICD 9). Mental illness was understood and interpreted in terms of psychodynamics of the symptoms. My interest in psychodynamic theory did not help me to convert it into any therapeutic success. However, it helped me to nurture my interest in theatre. As a physician then attached to Film and Television Institute of India at Pune, I had an opportunity to associate and interact with many theater and film personalities such as Girish Karnad, Dr. Jabbar Patel, Naseeruddin Shah, Satish Alekar and Dr. Mohan Agashe. This association helped me immensely in my practice. I acquired better communication skills and learned to apply it effectively to psychoeducate patients and caregivers. The enhanced communication skills helped me not only in my doctor-patient relationship but also to communicate effectively with fellow professionals. However, that was not a substitute for a search for better understanding and improved treatment skills. My seniors and colleagues would often come up with innovative ideas, which contributed to improved patient care. New Challenges The field of psychiatry has since witnessed major strides. We now have adequate data to claim that mental illness is a disease of the brain. Neuroimaging and success of pharmacology raised hopes of a significant breakthrough which is yet to become a reality. Today, we face multiple challenges and criticism from within (and outside the field of medicine in general and psychiatry, in particular) that threaten the practice of psychiatry. The new mental health legislation is awaiting Parliament's approval. My predecessors have made relentless efforts to get the voice of IPS reaches the lawmakers. Insurance companies do not acknowledge the needs of the mentally ill. The trend is changing but yet a lot more needs to be done. Closer to our clinical needs, DSM V is published. It was launched by our own alumni Dr. Dilip Jeste. Mastering the new classification will require much learning and re-orientation. ICD 11 is likely to be published in 2017. That will need some more new learning for all of us. Criticism against professionalism and alleged moral corruption by doctors is now being published in the world media and scientific literature. At a global level, the graph curves for cure, life expectancy and quality of life for patients of many serious and potentially life-threatening illnesses have shown major trend for the better. However the prevalence, morbidity and quality of life curves for mental illness have not shown any such bend for the better. Suicide rates, disability rates and eventual improvement rates of mental illness have not shown any significant improvement in the past three decades. …

Postgraduate training in psychiatry in India with focus on mumbai.

The present article traces the formation of the Indian Psychiatric Society and the progress of post-graduate training in psychiatry in India in general and Mumbai in particular. It covers the standard of psychiatric education, the goals and recommendations for improvisation of residency programmes, and the future of post-graduate psychiatric training.

Developments in psychiatry in India: Clinical, research and policy perspectives

Developments in psychiatry in India: Clinical, research and policy perspectives

Recent developments in community mental health: Relevance and relationship with the mental health care bill

Community mental health refers to the treatment of persons with mental disorders in the community. In the earlier periods, treatment of patients with mental illness was limited to the mental hospitals or asylums. This paper traces the beginnings of community psychiatry in India from the time Dr. Vidya Sagar initiated his famous experiment of treating patients with mental illnesses along with family members in tents outside the mental hospital, Amritsar. It then discusses the role of the National Mental Health Program and the District Mental Health Program. The role of the United Nations Convention on the Rights of Persons with Disability in leading onto the development of the current Mental Health Care Bill, 2013 is discussed. Authors critically evaluate some of the merits and drawbacks of the Bill as related to recent developments in community mental health in India.

Initiative for capacity building in academic psychiatry in India: The E-Journal Club of the Indian Psychiatric Society.

Byline: T. Sathyanarayana Rao, Chittaranjan. Andrade The previous issue of the Indian Journal of Psychiatry carried an editorial [sup][1] which observed that India does not have adequate psychiatric manpower, that there are few psychiatric centers in the country that are strongly oriented toward academics and research, and that, in consequence, many psychiatric centers with an interest in research may not have the necessary skills to demonstrate or create excellence in research. The editorial [sup][1] further observed that sustained exposure to good quality research in high ranking journals, combined with the development of the ability to critically evaluate a study and its place in the field, are together necessary to drive the desired improvements. The editorial [sup][1] referred to an initiative that was in the pipeline at the time of writing. This initiative sought to develop an e-platform for discussing and imparting training in research-related issues in the field of mental health and the allied neurosciences, linking postgraduate and academic psychiatry departments across the country. We are delighted to announce that, during the second week of March, 2015, the E-Journal Club (eJCIndia) initiative was successfully launched by the Task Force of the Indian Psychiatric Society on Psychopharmacology, along with the Task Force of the Indian Psychiatric Society on Workshops and Training, and with the support of the Department of Psychopharmacology at the National Institute of Mental Health and Neurosciences, Bengaluru. As of the first week of April, 2015, the e-group already has nearly 200 members, comprising postgraduate students, postgraduate teachers, and psychiatrists who are interested in academia even though their practice is not part of an academic environment. The eJCIndia group has completed several activities. The first activity presented an extract from the results of a meta-analysis [sup][2] and invited the membership to comment on whether they would alter their clinical practice based on a highlighted statistically significant finding. After discussion, an answer was provided that explained concepts in meta-analysis, aspects related to schizophrenia rating using the Positive and Negative Syndrome Scale (PANSS), and the clinical significance (as distinct from statistical significance) of a difference in PANSS ratings. Another activity sought to stimulate critical thought by examining paradoxes in the pillars of homeopathy, a school of treatment that enjoys popularity in India and elsewhere. Homeopathy considers that the administration of a diluted dose of a substance that produces a symptom will treat that symptom when that symptom occurs as part of an illness; the greater the dilution, the greater the efficacy of the treatment. It was discussed that the water that we drink has, in the past, come in contact with thousands of chemicals. This water, to use a concept in homeopathy, will therefore contain of those chemicals. Hence, water should be therapeutic for every disease! Alternately, how do we know that the memories in the water that we drink won't cancel out the memories of the homeopathic medicines? Then, what about the solvent that was used for the dilution of the homeopathic treatment; that would also have previously come in contact with plenty of substances with therapeutic or adverse effect potential, resulting with the potential to interact with the homeopathic substance(s). …