Psychiatric Approach Research Articles

Dopamine and Norepinephrine Differentially Mediate the Exploration-Exploitation Tradeoff.

Dopamine (DA) and norepinephrine (NE) have been repeatedly implicated in neuropsychiatric vulnerability, in part via their roles in mediating the decision-making processes. Although two neuromodulators share a synthesis pathway and are coactivated under states of arousal, they engage in distinct circuits and modulatory roles. However, the specific role of each neuromodulator in decision-making, in particular the exploration-exploitation tradeoff, remains unclear. Revealing how each neuromodulator contributes to exploration-exploitation tradeoff is important in guiding mechanistic hypotheses emerging from computational psychiatric approaches. To understand the differences and overlaps of the roles of these two catecholamine systems in regulating exploration, a direct comparison using the same dynamic decision-making task is needed. Here, we ran male and female mice in a restless two-armed bandit task, which encourages both exploration and exploitation. We systemically administered a nonselective DA antagonist (flupenthixol), a nonselective DA agonist (apomorphine), a NE beta-receptor antagonist (propranolol), and a NE beta-receptor agonist (isoproterenol) and examined changes in exploration within subjects across sessions. We found a bidirectional modulatory effect of dopamine on exploration. Increasing dopamine activity decreased exploration and decreasing dopamine activity increased exploration. The modulatory effect of beta-noradrenergic receptor activity on exploration was mediated by sex. Reinforcement learning model parameters suggested that dopamine modulation affected exploration via decision noise and norepinephrine modulation affected exploration via sensitivity to outcome. Together, these findings suggested that the mechanisms that govern the exploration-exploitation transition are sensitive to changes in both catecholamine functions and revealed differential roles for NE and DA in mediating exploration.

A Chinese Dance Therapy Framework.

Genuine Chinese dance therapy is in the ascendant and psychiatric approaches that involve a broad spectrum of principles such as ontological identity, social inclusion and collective support, aestheticisation and expressive catharsis, symbolic exorcism, trance and Buddhist mindfulness. Its models are based on a wealth of Chinese dance genres originating from various dynasties as well as cultural traditions of ethnic minorities. Due to different epistemological backgrounds of Western diagnostic manuals and traditional Chinese views of mental diseases, complex understanding of pathologies and therapeutic dynamics is needed. Therefore, this opinion piece suggests a theoretical framework that encourages interdisciplinary approaches as well as inclusive transcultural psychiatry and related philosophy of science.

Investigating AVHs narratives through text analysis: the proposal of Dialogic Science for tackling stigmatization

BackgroundAuditory verbal hallucinations (AVHs) are a significant symptom of various psychological conditions, often stigmatized and misunderstood. Moving beyond traditional psychological, psychotherapeutic and psychiatric approaches, recent research shifts focus on understanding AVHs through community perspectives and the resulting stigmatization. This research approach is crucial for better support and understanding of AVHs, however it still suffers from the lack of a rigorous and shared methodology for studying and reducing stigma.MethodsOur study, part of the Italian “PsicoVoice” project, aims to investigate community discourses on AVHs, in order to observe whether and to what extent they are drivers of stigmatisation processes. Engaging 268 participants with direct (hearers) and indirect (such as relatives and professionals) experiences of AVHs, the research analyzes a corpus of 54,320 instances using MADIT: a text analysis methodology which is both qualitative and quantitative. MADIT allows for an innovative examination of the rhetorical-argumentative structures within narratives, producing an index for measuring the narratives’ practical impact on people’ interactions around AVHs.ResultsThe analysis revealed that the overall community discourses are predominantly shaped by absolute and personal belief-driven modalities. This way of conveying sense, even with non-necessarily-judgmental words, contributes to a stigmatizing environment for individuals with AVHs, cementing a static representation dominated by personal opinions and reducing the potential for more nuanced, diverse interactions about AVHs.ConclusionThe study’s findings underscore the importance of addressing the narrative structures within community discourses. By intervening in these narratives, there is potential to shift towards a less stigmatizing social construction of AVHs. Thus, the article concludes using the results to provide some insights on how to generate these interventions. This approach could significantly impact how communities understand and interact with individuals experiencing AVHs, promoting more inclusive and supportive environments and interventions.

What is important in forensic psychiatric evaluation in people with Down syndrome? A sample from Türkiye

PurposeDown syndrome is one of the common genetic causes of intellectual disability. Adult with Down syndrome may have many psychiatric comorbidities. Therefore, their mental health status should be considered in legal proceedings such as criminal responsibility and legal capacity where they are involved. This study aims to highlight that individuals with Down syndrome are often referred directly to forensic psychiatry without undergoing an interview, despite the fact that this is a group with varied mental statuses.Design/methodology/approachThis study analysed the socio-demographic, clinical and forensic characteristics of eight adult individuals with Down syndrome for whom the Council of Forensic Medicine (CFM) requested an opinion on criminal liability and other legal situations between 2018 and 2022. The CFM is an authoritative institution to which cases from all areas of Türkiye are referred.FindingsThe mean age of the individuals with Down syndrome for whom a forensic psychiatric opinion was requested was 24.63 (±7.95) and the mean IQ level was 54.13 (±13.38). All cases were male, 6 / 8 were referred for assessment of criminal responsibility and 4 / 6 of those referred for assessment of criminal responsibility were referred for sexual offences. It was found that 5 / 8 of the cases had moderate intellectual disability and 3 / 8 of the cases had mild intellectual disability.Research limitations/implicationsRegarding the limitations of this study, the first one is the small sample size. Nevertheless, due to the low prevalence of people with Down syndrome in society, it is plausible that their stigmatization may not be reflected in the judicial system, even in cases involving violent behaviour. The second limitation is that the reports lack all psychiatric medical documents, including forensic psychiatric evaluations of individuals with Down syndrome. Additionally, additional diseases were recorded based on familial anamnesis. The third limitation is that this study is the first publication to investigate Down syndrome from a forensic psychiatric perspective. Thus, there is a lack of literature to make direct comparisons and references in the discussion section.Social implicationsThis is the first study about forensic psychiatric aspects for people with Down syndrome. The aim of this study was to examine the forensic psychiatric approach in Down syndrome, one of the most common genetic causes of intellectual disability, the situations in which forensic psychiatric assessment is required and the issues that might be considered important in this regard. Although there are various publications in the literature on the psychiatric conditions of individuals with Down syndrome, to our knowledge, this is the first study to evaluate individuals with Down syndrome in terms of forensic psychiatric evaluation. People with Down syndrome are known to have varying degrees of intellectual disability and different types of psychiatric comorbidity.Originality/valuePeople with Down syndrome are a heterogeneous group in terms of intellectual disability. The criminal responsibility and legal capacity of individuals may vary according to the legal situation. When requesting forensic psychiatric evaluation of these patients with psychiatric co-morbidity, patients should not be prejudged in terms of their level of mental competence and each case should be assessed individually.

CREATIVITY, GENIUS AND PSYCHOPATHOLOGY

The first part of this conference is a revision of the actual status of the scientific literature related to the concepts of genius, creativity and their association to psychopatology. The current con­cepts will be analyzed trying to explore the relevance and the real meaning of these concepts. In a second step we will analyze new empirical evidence that sustain a specific relationship between creativity, genius and psychopathology. The second part of the conference is dedicated to the most important pathographical studies of one outstanding creative genius. We will start this second part of these studies with the exploration of the life and the multiple artistic expressions of Vincent van Gogh. The Dutch genius left a huge amount of paintings and letters that has been analyzed from diferent perspectives, including biographical explorations, psicological studies and psychiatric approaches. The analisis should help us to understand in what way the psychopatological experiences can influence the development of outstanding artistic creativity.

Misperceiving Momentum: Computational Mechanisms of Biased Striatal Reward Prediction Errors in Bipolar Disorder

BackgroundDysregulated reward processing and mood instability are core features of bipolar disorder that have largely been considered separately, with contradictory findings. We sought to test a mechanistic account that emphasizes an excessive tendency in bipolar disorder to enter recursive cycles in which reward perception is biased by signals that the environment may be changing for the better or worse. MethodsParticipants completed a probabilistic reward task with functional magnetic resonance imaging. Using an influential computational model, we ascertained whether participants with bipolar disorder (n = 21) showed greater striatal tracking of momentum-biased reward prediction errors (RPEs) than matched control participants (n = 21). We conducted psychophysiological interaction analyses to quantify the degree to which each group modulated functional connectivity between the ventral striatum and left anterior insula in response to fluctuations in momentum. ResultsIn participants with bipolar disorder, but not control participants, the momentum-biased RPE model accounted for significant additional variance in striatal activity beyond a standard model of veridical RPEs. Compared with control participants, participants with bipolar disorder exhibited lower insular-striatal functional connectivity modulated by momentum-biased RPEs, an effect that was more pronounced as a function of current manic symptoms. ConclusionsConsistent with existing theory, we found evidence that bipolar disorder is associated with a tendency for momentum to excessively bias striatal tracking of RPEs. We identified impaired insular-striatal connectivity as a possible locus for this propensity. We argue that computational psychiatric approaches that examine momentary shifts in reward and mood dynamics have strong potential for yielding new mechanistic insights and intervention targets.

Minimally Verbal Individuals with Autism Spectrum Disorders/Intellectual Disability and Challenging Behaviors: Can Strategic Psychiatric Treatment Help?

(1) Background: Psychiatrists are increasingly required to treat minimally verbal (MV) individuals with autism spectrum disorder (ASD), intellectual disability (ID) and behavior problems without much published guidance. (2) Methods: We reviewed 80 charts of MV patients managed strategically for challenging behaviors, following IRB approval. Data extracted included demographics, ASD/ID level, diagnoses, epilepsy and medications. In this descriptive study, we examined the course of assessment and treatment and made recommendations for a strategic, person-centered approach. (3) Results: Of 53 males and 27 females, mean age 34 years (range 7–76), all had ID; 75 had ASD (94%). Diagnoses included seizures in 40/80 (50%), frequent aggression (89%), self-injury (80%), attention-deficit hyperactivity disorder (ADHD) (64%) and obsessive compulsive disorder (OCD) (34%). The commonest medication classes adjusted were antiseizure medications, antipsychotics, and non-stimulant ADHD medications. (4) Conclusions: Clinical impressions suggested that this strategic psychiatric approach was beneficial, notably a review of antiseizure and all other medications for polypharmacy, behavioral and other side effects, followed by a review of possible childhood/current ADHD and a trial of low-dose non-stimulant ADHD medications if warranted. Low-dose risperidone was often effective and tolerable for irritability and self-injury.

Psychiatry on fire: Climate change and the role of mental healthcare

IntroductionWhat is the psychiatrist’s role on a burning planet? As our world faces the existential ramifications of irreversible climate change, clinicians are contending with what purpose a normalizing institution like psychiatry can have in increasingly abnormal times.Objectives This presentation investigates the role of the modern mental health clinician by examining psychiatry’s current impotence in the face of climate crisis. It will be shown that current approaches are often complicit in psychiatry’s historical depoliticization of mental health and subsequent individualization of social concerns. It will be argued that the only way psychiatry can maintain its ethical obligations to its patients is by taking a courageous sociopolitical stance.MethodsEmerging from a multidisciplinary literature review on the relationship between psychiatry and social crises, this work examines our field’s response to climate change in particular. A focus is made on literature that explores psychiatry’s political obligations, current trends in climate psychiatry, and proposed social psychiatric approaches to the climate crisis.ResultsIt is shown that while ecological collapse tangibly affects our patients, psychiatry often fails to engage socio-politically with the crisis’ root causes. Framing intense reactions to climate change as trauma responses and developing neo-diagnoses such as “ecoanxiety” both risk individualizing inherently social experiences. However, Psychiatrists are also uniquely positioned to speak with authority about social crises and to articulate what a more comprehensive medical response to climate change might look like.ConclusionsGiven climate change’s disproportionate effects on disenfranchised populations, it is increasingly clear that health is inextricable from social circumstances. As a result, political inaction is incompatible with our ethical duty to serve patients’ health, both in the clinic and beyond it.Disclosure of InterestNone Declared

Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023.

We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.

Palliative Care Psychiatry: Building Synergy Across the Spectrum.

Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Lancement d’une recherche – action visant l’implémentation de la HCR20 à la maison d’arrêt d’Amiens

In France, an average of 40% of convicted prisoners are repeat offenders. To prevent disruptions in care that may lead to new offenses, the regional medico-psychological department (SMPR) of the Amiens prison first introduced short-term post-incarceration support (6 months) in 2021. The multidisciplinary team now intends to facilitate the transition to a desistance process for incarcerated men who are undergoing treatment in prison and to, provide support when they are released. The strategy consists of three main components: training, organization, and expanding the range of care. The team has already started training for three tools: HCR20 V3, SAPROF, and CAPP-IRS. The first pertains to the assessment and management of the risk of interpersonal violent relapse, the second focuses on identifying protective factors related to violence, and the third addresses psychopathy, a significant risk factor for violence. In terms of organization, care at the SMPR has been restructured to incorporate the assessment of the level of risk of relapse during detention and its reassessment during post-carceral follow-up. The aim now is to strategically address any identified dynamic risk factors, taking protective factors into account. The expansion of the care provided, begun in 2022, led to the opening of a therapeutic and integration cohabitation unit (TICU) in October 2023, serving as a “gateway” facility accommodating 5 men who have been released from custody supported by the SMPR in post-carceral care, also for a duration of 6 months. The primary objective of this observational, prospective, and single-center study is to measure the effectiveness of intra-carceral and post-carceral support – restructured around risk assessment and management tools – for individuals exiting the Amiens prison after achieving desistance at the end of the follow-up and for a period of 5 years. This effectiveness could be reflected in a reduction in psychopathic traits and in the level of risk of recidivism for those supported in post-carceral care, from the time of incarceration to the end of care. These mental health care professionals also wish to document the implementation of the three tools in their service and assess their predictive validity within their sample. The study also serves to evaluate the effectiveness of the experimental TICU program. The early identification of risk factors should improve the specificity and prioritization of risk prevention actions as part of routine care. Demonstrating the effectiveness of this extended treatment program, tailored to the needs of the outgoing incarcerated population, could lead to the replication of this specialized psychiatric approach in other penal facilities. The project is part of a common effort to break down barriers between the various sectors involved in the care of individuals who are released from prison. Collaborative multidisciplinary teamwork, both within the department and with mainstream psychiatric care facilities, lies at the core of the results of this research. Could it be possible to revitalize the individual and collective commitment of those working with patients who may present a risk of violence?

Breast Implant Illness Through a Psychiatric Lens.

Since their introduction in the 1960's, the safety of silicone breast implants has remained contentious due to concerns regarding carcinogenicity as well as a growing array of adverse psychiatric symptoms, which have now been termed 'Breast Implant Illness.' This article aims to explore the merits of a psychiatric approach to treating Breast Implant Illness by outlining how it is defined by psychiatric symptoms and categorized alongside other psychiatric illnesses. Furthermore, it is unclear whether the pathology of Breast Implant Illness is purely medical or psychiatric. However, the efficacy of the medical approach to treatment through a process called explantation, which involves removal of the implant and surrounding scar tissue, or capsule, is not strongly supported by existing data. A psychiatric approach to treatment, in conjunction with explanation, thus holds potential in remedying the novel and poorly understood Breast Implant Illness.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Folate and Its Significance in Depressive Disorders and Suicidality: A Comprehensive Narrative Review.

Depressive disorders pose significant challenges to global public health, necessitating effective prevention and management strategies. Notably, the occurrence of suicide frequently coincides with depressive episodes. Suicide is as a paramount global health concern that demands efficacious preventive strategies. Current psychiatric approaches heavily rely on pharmacological interventions but have had limited success in addressing the global burden of mental health issues. Suboptimal nutrition, with its impact on the neuroendocrine system, has been implicated in the underlying pathology of depressive disorders. Folate, a group of water-soluble compounds, plays a crucial role in various central nervous system functions. Depressed individuals often exhibit low levels of serum and red blood cell folate. Multiple studies and systematic reviews have investigated the efficacy of folic acid and its derivative, L-methylfolate, which can cross the blood-brain barrier, as stand-alone or adjunct therapies for depression. Although findings have been mixed, the available evidence generally supports the use of these compounds in depressed individuals. Recent studies have established links between the one-carbon cycle, folate-homocysteine balance, immune system function, glutamate excitation via NMDA (N-methyl-D-aspartate) receptors, and gut microbiome eubiosis in mood regulation. These findings provide insights into the complex neurobiological mechanisms underlying the effects of folate and related compounds in depression. Through a comprehensive review of the existing literature, this study aims to advance our understanding of the therapeutic potential of folic acid and related compounds in depression treatment. It also seeks to explore their role in addressing suicidal tendencies and shed light on the neurobiological mechanisms involved, leveraging the latest discoveries in depression research.

Psihijatrijski pristup tinitusu

Tinnitus is a symptom with a significant incidence in the general population, usually of unclear etiology, that can cause serious difficulties in people's daily functioning, significantly impair the quality of life, and have a negative impact on mental health. The paper aims to present a brief overview of current knowledge about this frequent and unpleasant phenomenon, including epidemiology, etiology, clinical presentation, diagnosis, and treatment. The paper highlights contemporary theories of tinnitus that link damage to the peripheral organ of hearing and the consequent neuronal changes involved in the subjective experience, which are the target sites for treating psychological disorders associated with tinnitus. The psychiatric approach to tinnitus is aimed not so much at reducing the sound intensity as at reducing the negative experience of this phenomenon and preventing the development or worsening of existing psychological disorders. The results of previous researches indicate numerous therapeutic options for treating tinnitus, including drugs, cognitive-behavioral therapy, and neuromodulation techniques with promising results.

Police of the psyche: the psychiatrist and psychiatry in Spanish punk songs.

Previous research has revealed that stigma is not restricted to people with mental health problems but extends to the professionals involved in their care and treatment. Unlike other artistic manifestations, the study of the depictions of psychiatry in popular music is still a less-explored topic. This article addresses the subcultural portrayals of the psychiatrist and psychiatric treatments within Spanish popular music. The predominance of negative depictions of mental health professionals as social control agents was a striking finding, given the topicality that characterises punk music. It is suggested that the allegorical role assigned to the psychiatrist in such a specific narrative framework, marked by ideological factors, could potentially explain these findings. In contrast to other cultural manifestations that show a tendency towards more balanced views of psychiatric treatment and practice, the negative representations in Spanish punk songs seem to have evolved little over decades, reflecting outdated views of the psychiatric approach.

Meaning-formation and sense of purpose in Morita therapy.

Morita therapy is one of the leading alternative psychotherapeutic approaches that has emerged from Japan and has adapted with notable success to the mores and demands of the Western medical establishment. Although still on the margin, Morita therapy has the potential to offer a viable option for those who seek therapeutic assistance for various neuroses and psychosomatic illnesses that culminate in psychiatric symptoms such as generalized anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder. Diverging considerably from conventional Western psychiatric approaches, Morita therapy has its own modes of conceiving mental illness and offers distinct curative methods that are in some ways akin to the techniques of meaning-centred psychotherapies, but in many other ways are rather different. In this paper, the meaning-formation and the building of a constant sense of purpose in Morita therapy is explored, with a special focus on how these relate to creating a stable psychological framework for the client.

Psychiatric Approach Management of Ambiguous Genitalia in Children and Teenagers

AbstractIntroductions: Ambiguous genitalia is a congenital disorder defined by atypical development at the chromosomal, gonadal, or anatomical levels of the sex organ. The incidence of ambiguous genitalia is estimated to be 1 in 4500-5500 births. The management of ambiguous genitalia takes an extended time. This can lead to psychiatric manifestations such as depression, anxiety, suicidal ideation, and substances. Objectives: The study aimed to describe the management of ambiguous genitalia in the scope of psychiatry to optimize the comprehensive treatment of the disorder and achieve a good quality of life for a person with ambiguous genitalia in Indonesia. Methods: This study is a literature review that collects from various sources of scientific journals related to the psychiatric management of the disorder. Results: Ambiguous genitalia should be treated by a multidisciplinary approach, with a mental health professional and other essential expertise of the team. Improper application of parenting in childhood can create a problem in adolescence and adulthood. Certain aspects of the management need a psychiatrist’s assistance. Psychological management should focus on giving reliable information that is not confusing and preparing children and adolescents to encounter general and sexual life problems. The family and the child should always be involved during the process. Conclusions: The purpose of the entire ambiguous genitalia treatment is to strengthen the patient and family’s adaptive coping to the stressors correlated with ambiguous genitalia and the management to promote good quality of life for children and adolescents.

Case of Recurrent Episode of Schizoprenia Paranoid in Pregnant Woman

AbstractIntroductions: Pregnancy is a stressor to women, in terms of biological as well as psychological. For individuals who previously received medication for schizophrenia in the past, it can be a triggering factor for the relapse of the illness. Here we describe a case of a pregnant woman who experiences a relapse in pregnancy. Case: The patient was a 40-year-old pregnant woman, brought to the emergency room after attacking her father by stabbing her father’s head with a knife. She was suspicious of her dad’s gaze at her. She was hostile towards healthcare workers when being examined. For her pregnancy, consultation with the Obstetric and Gynaecology department had been done to ensure that she and her baby were taken care of while being treated in the psychiatry ward. Discussions: The patient was diagnosed as having paranoid schizophrenia recurrent episodes. There was no complication found in her pregnancy, and she was scheduled for Sectio Caesarean as she was not mentally fit to do vaginal delivery. The psychiatric approach to the patient was atypical antipsychotic along with supportive psychotherapy. Psychoeducation and family therapy were also done to ensure that the patient’s family understand the illness and the importance of compliance with the medication. Conclusions: Pregnancy is one of the factors that lead to the relapse of schizophrenia in patients with a history of mental illness. Holistic treatment is needed to treat the patient to prevent the relapse of the illness.

Content analysis of suicide prevention web pages from perspective of preventive psychiatric approaches.

Suicide is a serious public health problem; however, suicides are preventable with evidence-based and often low-cost interventions. This study analyzes the online content of suicide prevention and helps websites in the context of preventive psychiatry. The universe and sample of the research consisted of 147 web pages whose links can be found on the most widely used international social media platforms and websites dedicated to suicide prevention. To conduct the content analysis, the crisis hotline guide prepared by the World Health Organization for suicide prevention and the guide prepared for media professionals were used in the data collection form created by the researchers. The majority of the websites were of European origin and were prepared by mental health and suicide prevention associations for suicide prevention and crisis intervention. Telephone helplines were the most common means of communicating with consultants via the web page. On the basis of the research findings, suggestions were generated regarding the scope, content, and sustainability of web pages for crisis intervention and suicide prevention prepared at the national and international levels.

Will increasing access to mental health treatment close India's mental health gap?

BackgroundIndia's National Mental Health Survey (NMHS) reports a treatment gap for common mental disorders of over 85 percent, which they attribute to lack of awareness and access to psychiatric services in India. Interventions aiming to close that treatment gap through task-sharing have gained significant traction in India, but have met with mixed success, particularly in long-term perspective. AimsWe critically examined the assumptions embedded in the NMHS report that the mental health treatment gap results from people in India lacking access and awareness to psychiatric services in a medium-sized Indian city. MethodWe conducted qualitative interviews with a community-based sample of 66 adult women in Mysuru city, Karnataka about the causes of distress in their lives, their understandings of distress, and their care-seeking behaviors. The overall aim was to assess their familiarity with psychiatry and their relative willingness to engage with it. ResultsWomen were familiar with psychiatric models of mental illness and with the psychiatric services available in their community. They recommended these services for hypothetical others but uniformly refused them for their own distress, even when this distress was severe. Women reported fears of stigma, doubts about psychiatric effectiveness, and connected their distress to social and structural causes rather than medical causes. They therefore did not perceive that clinical care could help them resolve their distress. ConclusionsCultural mismatch appeared to be responsible for at least a part of women's lack of use of psychiatry in the research context. We conclude with a set of recommendations addressing how future research and intervention could modify task-sharing approaches to incorporate culturally relevant conceptions of distress and its appropriate management, instead of relying solely on standard psychiatric approaches.