Indian Journal of Psychological Medicine最新文献

Background: The effectiveness of training methods in medical education is critical, particularly for primary care physicians (PCPs) who frequently encounter psychiatric issues in their practice. Traditional assessment methods often fail to evaluate skill acquisition in real-world clinical practice. The Translational Quotient (TQ) is proposed as an innovative outcome measure to assess PCPs' ability to apply psychiatric skills in their live outpatient consultation among their general patients. This study aims to evaluate the feasibility of using the TQ in real-world outpatient clinics and to understand the baseline psychiatric skills among PCPs using TQ.

Methods: Actively practicing MBBS-qualified PCPs enrolled in the Diploma in Primary Care Psychiatry (DPCP) program across various districts were invited to participate. Baseline TQ assessments were conducted in the PCPs' live clinics, with psychiatrists observing live consultations either remotely or in-person for the first five consecutive general consultations. Each consultation was scored using a standardized TQ proforma, which evaluated six criteria: elicitation of psychiatric symptoms, clinical reasoning, medication choices, counseling, time management, and overall clinical skills.

Results: A total of 25 PCPs participated, with an average baseline TQ score of 15.7% (4.72 out of 30). Most participants (72%) scored 5 or less, highlighting significant gaps in psychiatric skills. Analysis revealed no significant associations between TQ scores and PCP demographics such as age, gender, and prior psychiatric training, but regional differences were noted, with lower scores in Karnataka compared to Bihar.

Conclusions: The TQ is a feasible and practical tool for assessing real-world psychiatric skills among PCPs. The baseline scores indicate a pressing need for targeted psychiatric training to bridge the treatment gap in primary care. Future training programs should focus on enhancing diagnostic accuracy, treatment planning, and patient communication to improve mental healthcare outcomes in primary care settings.

Background: Clinical training in traditional medical education often needs more translational value, especially for in-service MBBS doctors working in primary health centers (PHCs), who provide first-line treatment for psychiatric disorders. To address this gap, a psychiatrist-led personalized mentorship program incorporating three live consultation-driven training (CDT) methods was developed to integrate psychiatric care into PHCs.

Methods: The authors designed and implemented a personalized mentorship program using three CDT methods tailored for in-service MBBS doctors. The CDT methods were applied through live consultations to facilitate real-time, real-life learning and integration of psychiatric care into primary health settings. Data from published articles and manuals on CDT methods were collected, focusing on their descriptions, effectiveness, principles, and advantages over traditional classroom training.

Results: Data indicate the effectiveness of the CDT methods to translate to real-life skills (translational quotient). The personalized mentorship program showed promising results in enhancing the confidence and competence of MBBS doctors in managing psychiatric disorders in PHCs. The CDT methods were found to be superior to traditional classroom training in terms of practical applicability and real-time learning.

Conclusion: The psychiatrist-led personalized mentorship program with CDT methods demonstrates the potential for significant improvements in the training of in-service MBBS doctors, facilitating the integration of psychiatric care into PHCs. These methods offer a practical and effective approach to bridging the gap in clinical training and can be replicated among medical students and residents across various medical and surgical specialties. Further research and longitudinal studies are recommended to validate these preliminary findings and explore the program's broader applicability.

Background: Relapse and treatment dropout are key challenges in opioid use disorder that need effective intervention strategies. Motivation enhancement therapy may be effective in improving opioid use disorder treatment outcomes.

Objective: To assess the effectiveness of group motivational enhancement therapy (GMET) in patients with opioid dependence.

Methods: It is an open-label, two-arm, parallel-group, randomized controlled trial (RCT). Participants include patients with opioid dependence and on opioid maintenance treatment, aged between 18 and 60 years. The intervention consists of six GMET sessions, each lasting about 45 minutes. Assessments will be conducted at four time points-baseline, six weeks, four months, and six months-using the Kessler psychological distress scale (K10), Recovery and Relapse Prevention Inventory Diagnostic (RAPID), WHO Quality of Life-BREF, Harm Reduction Self-Efficacy Questionnaire and Stage of Change Readiness and Treatment Eagerness Scale for drugs (SOCRATES 8D).

Conclusion: The customized GMET approach tailored to the specific needs of the local population is expected to enhance the effectiveness and feasibility of the intervention and its implementation.

Background: Many original studies have evaluated the validity and utility of the Alternative Model for Personality Disorders (AMPD) in Iran. However, the present review is a unique attempt to summarize the data in a critical framework to cover gaps in the AMPD research and determine future directions. The review aimed to explore the psychometric evidence for the AMPD, including reliability (alpha coefficient) and validity (construct, convergent, criterion, and incremental types) data in Iran. We also reviewed the overlap between the two AMPD criteria and the associations between the constructs and general psychopathology.

Methods: We searched PubMed, PsycNet, Google Scholar, and three national databases for English and Persian records related to the AMPD from January 2013 to 2023. Several keywords and criteria were applied to select studies before summarizing the data.

Results: The self-report scales were the first-line measures to assess the AMPD constructs, while interviews were rarely used. The research body provided relative support for both the unidimensional nature of Criterion A measures and the five-factor structure of Criterion B measures. Regarding Criterion B, however, there are still questions about the validity of the disinhibition factor and its clinical utility and generalizability.

Conclusion: Although a decade of research on the AMPD in Iran has contributed to improving our knowledge, the current review provided a more comprehensive and clear profile of this model's validity and generalizability to Iranian culture. We discussed the details of validation studies, limitations, and future considerations.

Background: Adolescents are susceptible to using tobacco because of early exposure to tobacco through family members, easy access, or peer pressure. School-based educational programs are crucial for raising awareness of the harms of tobacco, thus preventing its uptake among adolescents. Studies conducted recently have recognized the need to bring change and reinforce ongoing school-based anti-tobacco education programs. Our study protocol aims to evaluate the effectiveness of a revised school-based anti-tobacco education on susceptibility to tobacco use among school-going adolescents.

Method: Project TEACH (Tobacco Education and Awareness for Creating Healthier Adolescents) is an educational intervention that will comprise an animated video on the effects of tobacco on physical and mental health, along with dispelling myths about tobacco, which will be delivered along with a standard education program. The control group will only receive the standard school-based anti-tobacco education program. It will be conducted among students between 6^th to 10^th grade, with a sample size of 3,310 students.

Results: Bivariate relations between the main socio-demographic characteristics and susceptibility to tobacco use will be tested using Pearson or Spearman's correlation coefficients. For multivariable analyses, the binary logistic regression analysis is used to establish a risk model to correlate the socio-demographic factors with susceptibility to tobacco use and awareness of the harms of tobacco.

Conclusion: Project TEACH aims to provide a sustainable school-based anti-tobacco education intervention. It will help test the effectiveness of the revised intervention, which could be incorporated into the current school education program being conducted in the district.

Background: Facial emotion recognition (FER) deficits are being considered as core features of social cognitive deficits in schizophrenia, associated with socio-occupational dysfunction. Social cognition intervention programs have been shown to improve these deficits; however, there are no such intervention strategies in India. In this study, we aim to examine the efficacy of Training of Affect Recognition - Indian Version (TAR-IV) to enhance the FER abilities of people with schizophrenia.

Methods: In an open-label experimental design, 36 participants with schizophrenia underwent 12 sessions of TAR-IV as an add-on to treatment as usual (TAU), while 29 participants with schizophrenia continued TAU (pharmacological treatment with or without occupational therapy and vocational rehabilitation services). Clinical and functional assessments were done using the positive and negative syndrome scale (PANSS) and socio-occupational functioning scale. Emotion recognition abilities were assessed on the tool for recognition of emotions in neuropsychiatric disorders at baseline, post-intervention, and follow-up (two to three months post-intervention).

Results: The intervention group showed significant improvements in FER (P = .001) and socio-occupational functioning (P = .008) after receiving the TAR-IV, which remained significant at two months follow-up. A lower age of onset and poorer neurocognitive function at baseline predicted greater changes in emotion recognition ability following the intervention.

Conclusions: This study demonstrated the efficacy of TAR-IV, the Indian adaptation of social cognition intervention, in improving emotion recognition abilities and socio-occupational functioning in patients with schizophrenia. These findings need to be replicated in randomized controlled trials.

Background: Worldwide, common mental disorders (CMDs) (depression, anxiety, somatoform disorders) have a high prevalence in the community. About one-third of them experience disability. As the Indian Disability Evaluation and Assessment Scale (IDEAS) was originally designed by the Indian Psychiatric Society to assess disability in severe mental illnesses, it has not been widely used among CMDs. Our objective was to compare and establish a correlation between the level of disability obtained using IDEAS and the Sheehan Disability Scale (SDS) in CMDs.

Methods: A cross-sectional assessment of disability was performed among 220 consenting patients with CMDs. Disability scores of IDEAS and SDS were compared and correlated across the three varieties of CMDs.

Results: Age, gender, education, socioeconomic class, duration of illness, and duration of treatment exhibited significant differences among the three CMD groups. Both IDEAS and SDS show a milder level of disability; they did not differ significantly in their scores across CMDs. A strong correlation was seen between SDS and IDEAS across most domains.

Conclusion: The study revealed strong concurrent validity between the two scales, thus advocating that indigenously designed IDEAS can convincingly assess disability across the CMDs among the Indian population.

Background and objectives: Substance use among young college students in India poses public health challenges. This study seeks to uncover the motivation behind alcohol and illicit drug consumption, applying social norms theory.

Methods: This qualitative research utilized the framework method to analyze data from 14 college students (18-24 years) across various disciplines. Participants were selected using purposive sampling to ensure diversity in demographics and perspectives. Data collection was conducted online. The study used a combination of in-depth interviews (n = 14) and focused group discussions (n = 2). We used AtLAS.ti to facilitate data analysis. We used a mixed inductive and deductive coding approach. A mind map was generated to visualize the complex interplay between social norms and other individual and external mediators.

Results: We identified 10 themes, 20 subthemes, and 42 codes. The themes revealed descriptive (e.g., media and modernization) and injunctive (e.g., availability and legality) social norms that facilitate substance use and social disapproval and stigma that might deter young people from using substances. Family and institutional support were also found to play a protective role. The individuals also weigh the personal consequences (e.g., health and academic harm) and advantages (e.g., coping and relaxation) of substance use, which can influence their decision to use substances. Gendered norms and subtle differences in the social norms between alcohol and illicit drugs were also identified.

Conclusion: Our study illuminates culturally tailored substance use prevention/intervention strategies that operate at the social, individual, and policy levels.