Indian Journal of Psychiatry最新文献

Background: Stigma against persons living with substance use disorders (PLSUD) fosters social and health inequities.

Aim: We aimed to map different populations targeted by antistigma interventions, analyze specific characteristics of these interventions, and identify and categorize the theoretical frameworks used in these interventions.

Methods: We examined randomized controlled trials and quasi or pre-experimental studies targeting stigma against PLSUD. Using two English databases, our analysis involved mapping study populations, antistigma interventions, and trial characteristics through a narrative synthesis. We adhered to the Workgroup for Intervention Development and Evaluation Research (WIDER) checklist for assessing reporting quality. The Theoretical Domain Framework (TDF) identified intervention domains and constructs of the interventions.

Results: Of 698 studies, 29 met eligibility, with three from low-middle-income countries: 12 studies addressed the public, 11 self, and 5 structural stigmas. Reduction in stigma or improvements in knowledge of and attitude toward PLSUD was observed in 23 studies. Eight used social contact-based interventions, and one used direct social contact. Other interventions were psychoeducation, collaborative community care and linkage to social services, acceptance and commitment therapy, and gatekeepers' training. Five focused on injection drug use stigma; others were not substance-specific. Most studies reported the characteristics of the recipients (n = 28), mode of delivery (n = 28), and delivery settings (n = 24). Adherence to delivery protocol was the least reported (n = 5). The number of theoretical domains varied: 18 studies had 1-5 domains, 3 studies had 10, and 8 studies had 6-9 domains.

Conclusion: Social contact-based interventions show promise for PLSUD; future research must improve the quality of reporting and design theory-informed interventions.

Background: Glucocorticoids increase fear extinction in preclinical and human studies. Endogenous cortisol might influence who will benefit from exposure therapy in anxiety-spectrum disorders.

Methods: To investigate the impact of cortisol levels on within-session habituation of distress - a measure of success of exposure therapy - in obsessive-compulsive disorder (OCD) fifty-one OCD patients were studied during their stressful first cognitive-behavioral exposure therapy session with response prevention. Subjective units of distress, salivary cortisol, and salivary dehydroepiandrosterone (DHEA) were measured repeatedly before and during this afternoon session.

Results: No significant association of within-session habituation of distress and cortisol level during exposure was found. Calculating with the cortisol/DHEA ratio, similar results emerged.

Conclusion: Studies using endogenous diurnal fluctuation of cortisol and studies with administration of exogenous cortisol are needed to test whether glucocorticoids can augment exposure session outcome.

Transgender and gender diverse (TGD) individuals face significant barriers to healthcare, necessitating the development of TGD-friendly medical services. In India, healthcare systems have only recently begun addressing the unique needs of TGD individuals, particularly with the advent of the Transgender Persons Act 2019. This article outlines the establishment of a comprehensive TGD clinic within a multidisciplinary framework. Services span psychiatric support, endocrinology, and surgical interventions, including gender-affirming medical and surgical treatments (GAMSTs). Adherence to WPATH Standards of Care (SOC-8) ensures informed, patient-centered treatment for gender incongruence. The clinic also emphasizes pretreatment evaluations, hormone therapy protocols, surgical readiness, and regular monitoring. Additionally, patient education, consent processes, and social transition support are integral to the clinic's approach. Challenges include stigma reduction, staff training, financial sustainability for long-term treatments, and navigating gendered hospital infrastructure. The clinic's experience with 50 TGD individuals, including 18 who underwent gender reassignment surgeries, demonstrates the feasibility of such a service. Future goals include expanding services to nonemployees, providing advanced surgeries, and enhancing mental health support. This model serves as a framework for the creation of inclusive, holistic healthcare services for TGD individuals in India, aiming to improve both physical and psychological wellbeing.

Background: Psychosexual health is an important aspect of mental and physical wellbeing. Though Indian culture has a rich history of sexuality, over the years, our population has been reticent in talking about the same. With the advent of technology and new legislations protecting the rights of LGBTQIA population, awareness is also on the rise.

Methods: This review focuses on research published by Indian authors over the past 15 years, with search of databases like PubMed, Scopus, Google Scholar, and Litmaps to include original articles and case reports.

Results: Most studies focus on male sexual dysfunctions. Some emerging research showed promise in female sexual dysfunctions, the elderly, and the LGBTQIA population. The majority of research in sexual health continues to concentrate on dysfunctions, primarily prevalence, associations, or risk factors. Several studies investigated various medical/psychiatric comorbidities associated with sexual dysfunctions. A few studies have explored management strategies as well.

Conclusion: This review highlights the need for a more holistic approach to management to sexual health issues. It further underscores the importance of grassroots-level initiatives working on improving the training of all medical practitioners and postgraduate students, increasing the availability of services for sexual disorders, promoting sexual health research in areas with gaps, and raising awareness in the general population.

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.