Indian Journal of Psychiatry最新文献

Drug courts are specialized programs from the courts that aim to offer a chance to individuals with substance-related problems encountering law enforcement to take treatment rather than face incarceration. The aim of this debate is to critically debate the utility, applicability, and feasibility of drug courts in India. This is a theoretical debate based on the existing evidence and considerations of ground realities in the country. There is enough evidence that drug courts are effective in decreasing substance use and decreasing rearrests. These courts have been demonstrated to be cost-effective, and they seemingly decrease the burden on traditional courts. However, it can also potentially lead to discrimination of marginalized groups while at the same time can be seen to be punitive and coercive. Legal provisions exist that may facilitate the development of such programs. Nonetheless, there is a scrupulous consideration of the pros and cons of drug courts and their operational considerations in the local context.

Background: Information about the experience of practicing psychiatrists with the use of the Mental Health Care Act (MHCA), 2017, India, after 5 years of its promulgation has not been available.

Aim: The present study was carried out to understand the experience of the practicing psychiatrists in using and complying with the MHCA 2017 and to bring out the problems and suggested reforms, if any, in various provisions of the MHCA 2017.

Methods: An online survey by practicing psychiatrists of Indian Psychiatric Society on the various sections and provisions of the MHCA 17 was carried out through structured and open-ended responses. This paper presents the qualitative analysis of the open-ended responses.

Results: There were 600 respondents, who gave a total of 1239 (range 116-154) responses to eight open-ended questions about various provisions of the MHCA. Qualitative analysis revealed that most respondents opined for keeping the General Hospital Psychiatry units exempted from inclusion as the mental health establishment, thus treating physical illness at par with the mental illness; a separate stand-alone law for mental illness perpetuates stigma, asked for a larger representation of psychiatrists in the State Mental Health Authority and Mental Health Review Boards. Most respondents opined that the provisions of capacity assessment, nominated representative, and advance directive are a hinderance in treatment and should be amended; treating psychiatrists and family/caregiver's consent should suffice for supported admission, just like in other disciplines of medicine; and MHCA 2017 needs major amendments/repeal to make it convenient for patient care. Any unauthorized places/centers where persons with mental illness are kept should come under regulatory control of the state mental health authorities.

Conclusion: The survey has highlighted several deficiencies and operational difficulties in the current Act that hinder the delivery of mental health care to patients with mental illness in the country and need amendments.

The global community is currently facing a pressing challenge posed by climate change, which is profoundly impacting both human life and biodiversity. This encompasses issues such as rising global temperatures, heightened sea levels, amplified ultraviolet radiation exposure, more frequent and intense natural calamities, and the subsequent health risks. Additionally, mental health is also being impacted by these environmental changes. This review thoroughly examines the mental health consequences of climate change in various settings and among vulnerable populations, with a particular emphasis on India.

Background: Residual symptoms in individuals with bipolar disorder (BD) in remission are common, and they contribute to significant functional impairment and distress. The incomplete efficacy of pharmacological treatments and improvements in psychotherapeutic approaches has led to renewed interest in psychotherapy for this disorder. However, there are fewer studies addressing the same.

Aim: The study aims to examine brief CBT (cognitive behavior therapy) in addressing the residual symptoms in BD.

Method: A two-group randomized control design with multiple assessments (pre, post, and 3-month follow-up) was adopted. The sample consisted of 30 patients each in the intervention and Treatment As Usual (TAU) groups selected from the outpatient services of a tertiary mental health hospital. The variables studied were interepisodic symtpoms, functioning, and adherence to treatment using the tools of Beck Depression Inventory-II, Young Mania Rating Scale, and Beck Anxiety Inventory. The intervention group received a brief integrated CBT of 8-10 sessions conducted weekly over 2-3 months. The TAU group received treatment as usual and brief weekly telephonic contact.

Results: A significant difference was seen across the time points between the groups on all the variables. Significant changes in within group scores was noted in the intervention group on depressive and anxiety symptoms, medication adherence, and dysfunctional attitudes compared to the TAU group. However, there was no significant change in the functioning in both the groups. Larger within group effect sizes for anxiety, dysfunctional attitudes and emotion regulation, medium effect sizes for depression, and quality of life and small effect sizes for manic symptoms and medication adherence were found in the intervention group. Depression severity had a significant moderating effect on therapy outcomes.

Conclusion: The study shows effectiveness of brief CBT in reducing residual symptoms in the patients with BD. A longer-term follow-up would validate the findings.

Background: Functional near-infrared spectroscopy (fNIRS) is being increasingly utilized to visualize the brain areas involved in cognitive activity to understand the human brain better. Its portability and easy setup give it an advantage over other functional brain imaging tools. The current study utilizes fNIRS while performing a Stroop test, which is commonly used to assess the impairment of information selection in depression.

Aim: To compare cortical activation during the Stroop test in depressed individuals to healthy controls.

Methods: This cross-sectional study compared oxyhemoglobin (OxyHb) concentration changes in 39 individuals with depression to 40 healthy individuals. The Stroop test was construed in an event-related design with an intertrial interval of 2 seconds with jitter. A continuous wave fNIRS system was used for recording the cortical activity at 17 locations. Analysis of fNIRS data was done using statistical parametric mapping (SPM) for estimating general linear model (GLM) coefficients. Further analysis of the mean change of OxyHb concentrations during the 2 seconds after the presentation of congruent and incongruent stimuli was done between the groups using Mann-Whitney U test corrected for multiple comparisons with Bonferroni correction.

Results: While the number of errors and correct responses were similar between the groups, the reaction time for correct responses was more in the depression group in comparison to healthy individuals (t = -2.39, P = 0.01). For both healthy and depressive individuals in incongruent versus congruent task contrast, deactivation was seen in the region between the left middle frontal sulcus and frontopolar area of the brain (t = 0.41 and t = 0.21, respectively, P < 0.05). The depressed group had a higher mean change in OxyHb concentration following incongruent stimuli in comparison to the HCs (mean rank: HC = 32.63, depression = 47.56).

Conclusion: Our findings indicate that individuals with depression exhibited prolonged reaction times and distinct activation patterns of the frontal cortex compared to healthy individuals. The observed pattern of brain activation for congruent and incongruent tasks among both healthy and depressed individuals aligns with the findings of the prior studies, emphasizing the utility of fNIRS as a valuable instrument for assessing brain activity.

Nationa Medical Commission (NMC) had recently undertook the revision of Undergraduate CBME curriculum. the Authors were involved in Psychiatry curriculum revision. In this paper, authors explain the process of revision, the rationale behind the changes made and make specific suggestions for the better implementation of the revised curriculum.

Background: Schizophrenia is considered to be a condition that usually manifests at any age but commonly seen in young people and is associated with a genetic propensity in brain development.

Aim: The study explores the impact of aerobic training on brain architecture, hippocampal volume, cardiorespiratory parameters, and quality of life in young individuals with schizophrenia. The investigation focuses on the correlation between genetic predisposition, hippocampal atrophy, and diminished cardiorespiratory fitness, aiming to discern potential benefits of aerobic exercise on both physical and mental health outcomes.

Methods: A systematic search was conducted in major online databases, such as Cochrane, Embase, PEDro, Web of science and PubMed (Medline). Two authors independently evaluated possibilities of bias, retrieved data and decided which trials should be included in the analysis. Total of 13 published articles (randomized clinical and controlled trials) with 656 patients was included from January 2010 to December 2020.

Results: Following aerobic exercise training, people with schizophrenia presented with an increased hippocampus volume and enhanced cardiorespiratory endurance (P ˂0.05). Due to a lack of information, we rated the majority of the studies' risk of bias in relation to random sequence creation, allocation concealment, and selective reporting as uncertain.

Conclusion: Findings from the present review propose aerobic exercise program as a meaningful therapeutic intervention for schizophrenia patients in terms of maintaining appropriate brain architecture, increasing the hippocampal volume, improving cardiorespiratory parameters and health related quality of life.

Background: There is lack of data on bipolar disorder (BD) type II from India.

Aim: To compare the demographic and clinical characteristics of patients with BD-I and BD-II using the data of the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study).

Methodology: Using the data of the BiD-CoIN study, patients with BD-I and BD-II were compared for demographic and clinical variables.

Results: Out of the 773 patients, 59 (7.63%) participants had BD-II. Compared to BD-I, patients with BD-II had a higher income; were more often unemployed or housewives; had a higher mean number of episodes per year of illness, higher severity of depressive episodes, higher depressive affective morbidity, and a higher number of hypomanic episodes (in the lifetime, and number of episodes per year of illness); received lower doses of lithium and a lower number of medications; and had lower prevalence of alcohol dependence, higher prevalence of seasonality, a high proportion of them sought faith healing treatment, and a higher proportion of them have predominant depressive polarity.

Conclusions: Patients with BD-I and BD-II differ from each other on certain demographic and clinical variables. The difference in the clinical variables suggests that the patients with BD-II may require different treatment approaches for management.