Indian Journal of Psychiatry最新文献

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.

Background: There is limited data on subtyping of bipolar disorder (BD) based on age of onset (AOO) from developing countries.

Aim: Accordingly this study aimed to compare the long-term course of bipolar disorder among patients with early onset (onset before 18 years) and later AOO (onset after 18 years).

Methods: Using the data of the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study), the study sample was divided into two groups and the groups were compared for the course of illness, predominant polarity, cognitive impairment, disability, and insight.

Results: The study shows that compared to BD patients with later AOO, those with early AOO have a higher number of depressive and manic episodes, spend significantly lower time in episodes, have lower level of cognitive impairment, a higher proportion of them have history of relapse due to poor adherence, higher proportion have history of hospitalization, receiving electroconvulsive therapy (ECT), a higher prevalence of unipolar mania, predominant manic polarity, and receive higher mean dose of valproate.

Conclusion: To conclude, this study suggests that age of onset of BD has impact on the course of illness in the form of more severe illness.

Background: Stigma toward mental illness remains a major barrier to utilization and provision of mental healthcare services. Stigma and negative attitudes toward mental illness fuel each other to create a vicious cycle hampering effective care. After overcoming numerous barriers, persons with mental illness (PMIs) should not be victims to professional stigma and negative attitudes by healthcare workers (HCWs).

Aim: To assess healthcare workers' stigma and attitude toward persons with mental illness and determine their association with sociodemographic and work-related factors.

Methods: In this cross-sectional study, sociodemographic and professional data of 275 tertiary care HCWs was collected. Their stigma and attitude towards mental illness was assessed using Attribution Questionnaire-27 (AQ-27) and Mental Illness: Clinician's Attitude Scale (MICA), respectively. Results were analyzed using SPSS 24.

Results: The mean AQ-27 and MICA scores were 114.02 (±25.67 SD) and 49.32 (±9.70 SD), respectively, indicating high levels of stigma and negative attitudes. Nurses and Residents had the highest levels, followed by Interns and Clinical faculty, and Pre and Para Clinical faculty the lowest. Commonly endorsed factors included Avoidance, Coercion and Pity, with Anger the least endorsed. Younger HCWs and females displayed higher negative attitudes, with males endorsing more Pity and Coercion. Psychiatric HCWs exhibited more positive attitudes, and those with a family history of mental illness showed lower negative attitudes compared to those without such history.

Conclusion: The study highlights significant stigma and negative attitudes toward PMIs among HCWs. Addressing these attitudes is crucial for improving mental healthcare service delivery and utilization.