Indian Journal of Psychological Medicine最新文献

Background: While stigma surrounding mental illness continues to affect management, there are hardly any studies reflecting any change following psychiatric admission. We aimed to examine how self-stigma changes during treatment in an inpatient setting and how it relates to improvements in symptoms and functioning.

Methods: We analyzed stigma, depression, anxiety, stress, insight, well-being, functioning, and disability in 100 consecutive patients at admission and discharge in a psychiatric hospital in Kerala.

Results: At admission, 34.5% (confidence interval [CI]: 24.5-45.7) of patients reported self-stigma, which decreased to 23.2% (CI: 15.1-32.9) at discharge; the stigma score decreased from 17.1 ± 6.6 to 14.9 ± 4.7 (p < .005). However, stigma levels did not change between admission and discharge for most (68.3%) patients; 87.5% had minimal stigma, with no scope for further reduction. In a minority (7.3%), stigma severity increased. Stigma correlated positively with depression, anxiety, functioning, and insight, and negatively with age and well-being at admission; and at discharge, positively with stress. Patients reporting stigma had higher depression, anxiety, insight, and poorer well-being both at admission and discharge.

Conclusions: Most patients had a lower level of stigma; average stigma severity decreased during psychiatric admission; however, in a minority, it increased. While usual care was beneficial, the effectiveness of a proactive approach to stigma reduction warrants further study.

Background: Child sexual abuse (CSA) has profound psychiatric and developmental consequences; however, the relationship between specific abuse characteristics and mental health outcomes in the Indian context remains insufficiently studied. This study examined psychiatric morbidity, developmental psychopathology, and functional impairment among children with CSA.

Methods: A cross-sectional study was conducted with 100 children aged 6-17 years whose cases were registered under the Protection of Children from Sexual Offenses (POCSO) Act and referred to a government-supported protection center. Data were collected using a semi-structured interview, the Developmental Psychopathology Checklist (DPCL), DSM-5-TR-based clinical evaluations, and the Children's Global Assessment Scale (CGAS). Associations between abuse characteristics and psychiatric outcomes were analyzed using χ ² tests and logistic regression.

Results: The mean age was 10.87 years (SD = 3.22). Perpetrators were known to the child in 66% of cases, and 55% of participants experienced vaginal or anal penetration. Overall psychiatric morbidity was 53% (95% CI: 43.2-62.6). Common diagnoses included post-traumatic stress disorder (28%, 95% CI: 20.0-37.6), conduct disorder (21%, 95% CI: 14.2-30.0), and depression (17%, 95% CI: 10.9-25.5). Suicidality was reported in 12% (95% CI: 6.8-19.8). Vaginal/anal penetration was associated with higher rates of PTSD (χ ² = 8.67, p = .003) and depression (χ ² = 4.15, p = .04). Longer duration of abuse was associated with higher suicidality (χ ² = 6.30, p = .01). More severe physical injury was associated with higher suicidality (χ ² = 6.30, p = .01). Self-blame was associated with higher rates of adjustment disorder (χ ² = 4.98, p = .02). The mean CGAS score was 69.20 (SD = 12.16), reflecting mild-to-moderate functional impairment.

Conclusions: CSA survivors exhibit substantial psychiatric and functional difficulties, with specific abuse patterns linked to distinct mental health outcomes. Early trauma-focused assessment, caregiver psychoeducation, and timely psychosocial interventions are crucial to improving recovery trajectories.

Purpose of the review: Bollywood (Hindi cinema) is a powerful global medium that shapes public attitudes toward mental healthcare. This scoping review systematically maps and characterizes the portrayal of mental health professionals (MHPs) in contemporary Bollywood films to identify dominant stereotypes, representational patterns, and potential gaps in representation.

Collection and analysis of data: A scoping review was conducted in accordance with the Arksey and O'Malley framework. A systematic search of online databases identified Hindi-language films released between 2011 and 2024. Inclusion criteria were applied to select films featuring MHP characters. Data from each portrayal were systematically charted to analyze demographics, professional competence, ethics, and narrative function. Thirty-five films featured 42 distinct MHP portrayals. The findings revealed a consistent pattern of negative representation. MHPs were presented as minor, unnamed characters with ambiguous professional status. MHPs were frequently portrayed with clinical incompetence (>70%) and major ethical violations (>73%), with these harmful stereotypes appearing persistent over the decade. A culturally specific pattern emerged where supernatural narratives frequently invalidate MHP expertise. Psychotherapy, though depicted, was often caricatured or undermined, and treatment outcomes were typically ineffective. A significant gap was identified concerning the lack of nuanced or positive MHP role models.

Conclusions: The systematic misrepresentation of MHPs in Bollywood portrayals risks reinforcing harmful stereotypes, trivializing professional care, and discouraging help-seeking in a country already facing a vast treatment gap. This review highlights an urgent need for the film industry to move beyond caricature and to create more accurate, ethical, and humanizing portrayals that can contribute positively to public mental health literacy.

Background: Depression is a significant global health issue, often accompanied by suicidality, which requires urgent and effective interventions. Oral ketamine is emerging as a potential rapid-acting treatment, but data on its efficacy and tolerability remain limited, particularly in the Indian context. Thus, this retrospective study was conducted to assess the response to oral ketamine in patients with depression and suicidality.

Methods: A retrospective cross-sectional study was conducted on 41 patients diagnosed with major depressive disorder (MDD), bipolar depression (bipolar affective disorder [BPAD] depression), or who had suicidal ideation, all of whom were administered oral ketamine therapy at a tertiary care psychiatric institute in India. Depression severity and suicidal ideation were assessed using the Hamilton Depression Rating Scale (HAMD) and the Modified Scale for Suicidal Ideation (MSSI), respectively, at baseline and after the third ketamine session. Sociodemographic and clinical variables were analyzed to explore their association with treatment outcomes.

Results: The mean reduction in HAMD and MSSI scores post-third ketamine session was 8.19 (p < .001) and 4.95 (p < .001), respectively, indicating significant improvements in both depressive symptoms and suicidal ideation. Common side effects included dizziness, nausea, and hypertension, and the least common was diarrhea.

Conclusions: Oral ketamine appears to be an effective and well-tolerated option for rapidly reducing depressive symptoms and suicidal ideation in patients with MDD and BPAD depression. It can be used in outpatient settings to provide immediate benefit to patients. Future studies with robust, prospective designs are needed to determine optimal dosing, evaluate long-term safety, and establish sustained efficacy.

Adolescents with substance use disorders often have co-morbid disruptive behaviour disorders, due to shared aetiology or bidirectional feedback. Such patients require a more nuanced assessment, as discussed in this editorial. Limited studies exist on the management of the comorbidity. Psychosocial interventions, especially those involving the family, are the most important.

Family accommodation (FA) is prevalent in obsessive-compulsive disorder (OCD). When patients refuse treatment, the impacts are more severe-with poorer clinical outcomes, greater FA, and more caregiver burden. In these cases, caregiver interventions are an essential clinical priority. However, clinical documentation of structured, culturally informed interventions for FA and caregiver burden for adults with OCD, in the absence of patient participation, remains limited. This case study describes an eight-session caregiver-focused intervention for a 26-year-old male experiencing burnout while accommodating his twin sister with OCD, who was refusing treatment. The intervention, grounded in cognitive-behavioral principles, targeted maladaptive caregiving patterns, reinforced boundary-setting, and facilitated shifts in caregiver behaviors and family routines. Post-intervention assessments indicated reductions in FA and emotional distress, with gains maintained at the one-month follow-up. This case highlights the feasibility and clinical utility of caregiver-directed approaches in adult OCD. It underscores the need for structured support for caregivers in collectivist cultures and suggests that even indirect interventions can disrupt symptom-maintaining cycles and promote systemic well-being.