Indian Journal of Psychiatry最新文献

Background: There has been a consistent increase in the use of transcranial direct current stimulation (tDCS) in psychiatric practice and academic research in India. However, no systematic effort has been made to map the trajectory of clinical research involving tDCS within Indian institutions.

Methods: PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for tDCS studies with Indian affiliations published until May 2025.

Results: Data on study design, diagnosis, stimulation parameters, authorship, institutions, and funding were analyzed. A total of 106 studies were included. Most publications were case reports (37.4%), followed by interventional studies (27.1%) and randomized controlled trials (26.2%). Schizophrenia (36.4%) and obsessive-compulsive disorder (OCD) (10.3%) were the most studied conditions. The left dorsolateral prefrontal cortex (DLPFC) was the most targeted site (53.8%). Conventional tDCS was used in 57.5% of studies.

Conclusion: Indian tDCS research in psychiatry is increasing but remains limited compared to global trends.

Background: Teenagers and young adults (TYA) with autism spectrum disorder (ASD) in India face systemic barriers in education, employment, and healthcare, worsened by the lack of culturally tailored services.

Aim: This study aimed to design and validate a culturally sensitive assessment framework for TYA with ASD, incorporating expert and caregiver input to identify barriers and inform scalable interventions.

Methods: Using an operational research design, we integrated real-time interventions with a three-tiered assessment framework (clinical, home-based, and community evaluations). Forty-three participants aged ≥14 years were recruited via convenience sampling. Standardized tools (Vineland Adaptive Behavior Scale-2, DSM-5 Clinician-Rated Severity, Wechsler Abbreviated Scale of Intelligence-II) and structured interviews guided individualized interventions, including behavioral, pharmacological, and vocational strategies. Manual thematic analysis with inter-coder reliability provided qualitative insights.

Results: Significant psychiatric comorbidities were found in 82.9% of participants [e.g. Intellectual Disability, Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety], alongside high school dropout rates (31.7%) due to the behavioral and academic challenges, and limited vocational training access (17%). Gender disparities showed males with externalizing behaviors and females often underdiagnosed due to internalizing symptoms. Families reported financial strain, caregiver burnout, and social isolation, with siblings experiencing both neglect and support roles. Thematic analysis highlighted needs for family support networks, sexuality education, and vocational day centers, leading to targeted services launched in November 2024.

Conclusion: This study, one of India's first to combine multidisciplinary assessments with real-time interventions, offers a replicable framework for scalable, family-centered ASD care. It underscores the need for adaptive policies and targeted interventions to address systemic barriers in education, mental health, and vocational integration for TYA with ASD.

Background: The elderly population is predicted to reach 20% of the total Indian population by 2050. Among people over 60 years, depression is a common treatable mental health issue. Lack of clear clinical presentation in elderly and associated stigma hinders its diagnosis.

Aim: To estimate prevalence of depression and its determinants among elderly population.

Methods: This study was the community-based cross-sectional study, among elderly individuals aged ≥60 years from rural, urban, and tea-garden areas of Dibrugarh district. With a 37.3% prevalence of depression among Assam's elderly population and 5% absolute precision, the sample size was determined as 360, and multi-stage sampling technique was used. GDS-15 scale for depression and Katz (ADL) for functional status of elderly were utilized.

Results: Prevalence of elderly depression was 25.6%. Highest rate of depression (42.9%) was seen among ≥80 years-old. Elderly who were financially dependent (30.6%), illiterate (35.2%) had significantly higher depression, while gender, place of residence, marital status, family type, and socioeconomic status, did not exhibit statistical significance. A negative life event within a year, multi-morbidity, history of fall, low physical activity, and physical dependence were significantly associated with depression.

Conclusion: Financial dependence, negative life events, inadequate physical activity, and multi-morbidity were independent predictors of depression among elderly.

Telemedicine has improved healthcare delivery by enhancing treatment access and convenience. India's telemedicine adoption was limited before COVID-19 due to legal ambiguity and judicial barriers, but the pandemic prompted the development and implementation of Telemedicine and Telepsychiatry Operational Guidelines. The telemedicine guideline established ethical frameworks, consultation protocols, and medication categories for tele-consultation. This viewpoint article examines the advantages and limitations of current telemedicine guidelines in the context of addiction treatment. Given India's high substance uses prevalence, rural healthcare disparities, and a huge substance use disorder treatment gap, telepsychiatry offers a path to improve treatment access and thereby, reducing stigma and improve treatment outcomes. Even though the current telemedicine guideline is a good first step, it is severely limiting addiction treatment. The major limitations are restrictive medication lists, lack of evidence-based recommendations, privacy concerns, and regulatory gaps. Key recommendations include reclassifying non-abusable medications and adequately addressing legal and privacy concerns.

Despite its proven safety and effectiveness, Electroconvulsive Therapy (ECT) is seldom utilized in children and adolescents with severe mental illnesses. Using two clinical case scenarios, we aim to illustrate the influence of the Mental Healthcare Act, 2017 (MHCA 2017), on ECT among children and adolescents in India. Either case required emergency ECT per clinical protocols, but access was denied due to MHCA 2017 restrictions-specifically, the requirement for prior approval from the Mental Health Review Board (MHRB). Data was obtained from clinical records, treating psychiatrists, and legal documentation. MHCA 2017's Section 95 prohibits unmodified ECT and restricts ECT in minors unless guardian consent and MHRB approval are obtained. These provisions resulted in impediment of treatment in our cases, leading to clinical deterioration, prolonged suffering, and heightened morbidity risk. While MHCA 2017 aims to protect patient rights, its rigid, regulatory structure regarding ECT in minors may inadvertently obstruct life-saving treatment in critical cases. These barriers prolong illness, increase risk, and reduce access to effective intervention. Reevaluation of current regulations is urgently needed to ensure a balanced framework that safeguards rights without compromising timely care.

Background: Globally, proportion of women using psychoactive substances has increased substantially.

Aim: We aimed to assess the extent and pattern of depiction of alcohol and other substance use by women in Hindi-language movies and analyse the trends of depiction over the three decades selected for the study (I: 1961-1970; II: 1981-1990; and III: 2001-2010).

Methods: We selected the top five grossing movies for each year of the three decades. Across the decades, we compared quantitative variables to assess for changes in portrayal of alcohol and other psychoactive substance use by women and a qualitative content analysis was also performed.

Results: Of the 150 movies analyzed, 36 movies (24%) had scenes (n = 79) depicting any form of psychoactive substance use by women. The cumulative duration of these scenes was approximately 4.5 hours. In majority of the scenes (74.4%), female lead was shown to be consuming any form of substance, with alcohol being the most dominant (41.1%). Enjoyment emerged as the most cited reason especially in decade III (26.6%). Tobacco use decreased by decade III; however, portrayal of alcohol changed with more use of beer and wine. This decade also had a significant proportion of scenes set in parties, bar etc., and the context was to show the "coolness" or independent nature of the women.

Conclusion: There seems to be an increasing trend of use of alcohol and other psychoactive substance use, amongst female characters in Bollywood, with negative consequences rarely shown. The impact of these depictions on Indian viewers especially women needs further study.

Background: Generic instruments recommended for disability assessment are not useful in delineating the exact contribution of psychiatric disability to total disability following traumatic brain injury (TBI).

Aim: To develop and validate a tool to assess psychiatric disability due to the behavioral and cognitive impairments following TBI, named the Cognitive and Behavioral Inventory (CBI).

Methods: The study was conducted in a tertiary care hospital in South India. The development of the tool was performed after a thorough literature search and discussions with experts. The face, content, and linguistic validity of the tool were established. Criterion validity was established by correlation with the Montreal Cognitive Assessment (MoCA) and Neuropsychiatry Inventory Questionnaire (NPI-Q) for cognitive and behavioral domains, respectively. The Intraclass correlation was calculated to assess the inter-rater reliability.

Results: The item-level content validity index of the tool ranged from 1 to 0.86. The scale-level content validity index, calculated using the averaging and universal agreement method, was 0.97 and 0.88, respectively. The point estimate of criterion validity assessed using Pearson's correlation coefficient for the cognitive domain of the tool with MoCA was 0.87, and the behavioral domain of the tool with NPI-Q was 0.79. The intraclass correlation coefficients for the full scale, behavioral domain, and cognitive domain were all 0.99.

Conclusion: CBI is a tool with high face, content, linguistic, and criterion validity, as well as good interrater reliability. It can be used to assess the behavioral and cognitive impairments following TBI, and thus psychiatric disability, in a very short time by a clinician.