Indian Journal of Psychological Medicine最新文献

Purpose of the review: Attitudes toward mental illness and psychiatry (ATMIP) have been widely studied, and various instruments have been developed to assess them. However, the characteristics and psychometric properties of these instruments have not been comprehensively reviewed, leaving researchers uncertain about which scale to use in specific contexts. This review aims to synthesize the features of these scales, including their psychometric properties.

Collection and analysis of data: Following Arksey and O'Malley's scoping review framework, a comprehensive search was conducted across Scopus, PubMed, Cochrane, and Google Scholar. Studies reporting scales designed to assess ATMIP among medical students and healthcare professionals (HCPs) were included. Data were extracted on scale characteristics, domains, psychometric evaluation, and cultural adaptations. Twenty-two scales were eligible for inclusion. Most originated in Western contexts and were primarily developed for medical students and HCPs. The majority used Likert-type items or vignette-based assessments, and 19 scales (86.3%) reported psychometric evaluation. While most scales were initially developed in English and global south setting and later adapted to non-Western settings, contextual sensitivity and cultural validity varied. Overall, despite frequent reporting of psychometric properties, the applicability of these instruments across diverse cultural and educational contexts remains uncertain.

Conclusions: This review provides researchers and educators with a consolidated understanding of existing scales, guiding informed use, adaptation, and potential development of culturally relevant instruments for ATMIP assessment. Careful selection and adaptation to local needs are essential to accurately assess attitudes toward psychiatry globally.

Background: Despite its high prevalence, autism spectrum disorder (ASD) presents specific difficulties for families, especially in India. Where access to early and affordable treatment is limited. Parents often struggle to manage behavioral and developmental issues due to shortages of trained professionals and high therapy costs. This study aimed to develop and validate a culturally appropriate, low-cost, home-based psychosocial intervention module for parents of children with ASD. This study presents the development and validation of a culturally relevant, home-based psychosocial intervention module for parents of children with ASD in India. Unlike previous research that often focused on clinic-based or resource-intensive interventions, this module integrates evidence-based strategies with parental perspectives and expert input to address real-world challenges in resource-limited settings. Its novelty lies in combining child-focused techniques with parental well-being strategies within a structured eight-session format. By emphasizing accessibility, cultural sensitivity, and feasibility, this work contributes a practical and scalable model that complements existing treatments and bridges critical service gaps.

Methods: The study was conducted in two phases between August 2022 and November 2023. Phase I (development of module): The module was systematically developed through literature review, semi-structured parent interviews, and multidisciplinary expert consultations to identify culturally relevant and feasible intervention components. The preliminary module, consisting of eight structured sessions that integrate behavioral, communication, and emotional regulation strategies derived from Applied Behavior Analysis (ABA) and play therapy principles, was developed based on these inputs. Phase II (validation): The drafted module underwent content and face validation by 15 domain experts using structured rating scales, and item-content validity index (I-CVI) values were computed for each session.

Results: The development phase identified key parental challenges, including limited access to therapy, stigma, and financial constraints. In the validation phase, experts rated all module items as highly relevant (I-CVI = 0.86-1.00). Qualitative feedback emphasized the module's clarity, contextual relevance, and practicality for Indian families.

Conclusion: The validated intervention module offers a practical, evidence-based framework for ASD interventions in resource-limited settings. A further pilot study will evaluate its acceptability, usability, and impact on parental outcomes and symptom management.

Background: Genetic factors contribute to the development of opioid dependence syndrome (ODS), with evidence suggesting that the neuropeptide galanin, which plays a role in the stress response, may influence addiction risk through its receptor galanin receptor 1 (GALR1). However, this area is largely unexplored in the Indian context.

Methods: This case-control study included 85 opioid-dependent patients and 85 healthy controls, all males, recruited from a tertiary care hospital in North India. All participants were assessed using a socio-demographic proforma, a case record form for substance use parameters, and the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST) to assess harmful use of other substances. Participants were genotyped for polymorphisms in the galanin gene (GAL rs948854, rs3136541) and its receptor gene (GALR1 rs9807208).

Results: The GAL rs3136541 and GALR1 rs9807208 polymorphisms showed significant differences in the genotypic distribution between cases and controls. The GALR1 rs9807208 minor allele (G) was associated with a 2.27-fold increased risk of opioid dependence (95% CI = 1.17-4.41; p = .01). However, no association was found between these polymorphisms and substance use patterns or related clinical parameters.

Conclusions: This study provides preliminary evidence of an association between GALR1 rs9807208 polymorphism and opioid dependence in an Indian population, suggesting a potential genetic basis for addiction risk. Further studies with larger samples could be considered to confirm these findings and also to explore gene-environment interactions in opioid dependence.

Nonprobability sampling, especially the consecutive and snowball methods, is common in Indian mental health research due to their practical utility. Yet, their unchecked use shapes whose experiences are heard and whose are excluded. This viewpoint critiques their ethical costs and proposes realistic reforms for inclusive, responsible data collection.

Background: Schizophrenia is a multifaceted and heterogeneous psychiatric disorder, marked by the presence of positive, negative, and cognitive symptom domains. In the chronic course, few symptoms remain persistent, leading to socio-occupational impairment. Few studies have used memantine (an NMDA receptor antagonist) as an adjunctive treatment, noting reductions in both positive and negative symptoms, accompanied by improvements in cognitive performance and overall functioning. The present study explored the effectiveness of adding memantine for cognitive symptoms in schizophrenia with a chronic course.

Methods: This prospective, single-arm, open-label study used a pre-post design. A total of 30 individuals with schizophrenia, diagnosed based on ICD-10 criteria and having an illness duration of more than two years, were included. Socio-demographic data were collected, and the Addenbrooke's Cognitive Examination Scale-Revised (ACE-R) was administered at baseline. Subsequently, memantine was added to their ongoing treatment regimen. The ACE-R assessment was repeated after eight weeks. Data was analyzed using R software version 4.4.1.

Results: Different ACE-R score variables were compared before and after adding memantine. A significant relationship was found between ACE-R scores after adding memantine and the baseline scores (p < .001), except for the writing subcomponent of the language variable.

Conclusions: The results of this study suggest that adding memantine to an antipsychotic treatment regimen may provide beneficial effects on cognitive symptoms in chronic schizophrenia, with good tolerability and minimal adverse effects.

Trial registration: The study was registered under the Clinical Trials Registry in India (CTRI), CTRI/2024/12/077774.

Background: Psychiatric disorders contribute significantly to the global burden of disease, especially in rural areas with limited healthcare resources. Psychiatric medications are essential for managing these conditions, but their availability and appropriate use remain inadequate at Primary Health Centers (PHCs) in India.

Methods: This is a secondary analysis conducted within a larger cluster randomized controlled trial (RCT) evaluating the add-on Online Mental Health Training (OMHT) for primary care doctors (PCDs) compared with training as usual (TAU). The primary outcomes of the RCT were patient-level diagnostic and treatment concordance with psychiatrist assessments, reported separately. In this article, we focus on psychiatric medication requisition patterns as a proxy for clinical practice improvement among PHCs in Tumkur District, Karnataka, India. Psychiatric medications procurement data were extracted from a centralized drug procurement portal across three phases: Pre-training, training and assessment, and post-training.

Results: Within-group analysis over time showed a statistically significant increase in the proportion of PHCs procuring amitriptyline in both the OMHT arm (p = .01) and the TAU arm (p = .03). Additionally, in the OMHT arm, there was a significant increase over time in the proportion of PHCs procuring alprazolam (p = .03) and clonazepam (p = .02). In the between-group comparison of total quantities procured during the combined training and post-training phases, the OMHT arm demonstrated significantly higher procurement of escitalopram (p < .01) and risperidone (p < .01) compared to the TAU arm, indicating greater confidence in prescribing practices of key psychiatric medications among trained PCDs.

Trial registration: Clinical Trials Registry of India (CTRI/2024/02/062906).

Background: Prolonged grief disorder (PGD) significantly impacts individuals following bereavement, particularly under conditions of sudden loss and disrupted mourning. Despite Hindi being one of the most widely spoken languages, no validated PGD assessment tool has existed for Hindi speakers. This study aimed to translate, adapt, and validate the Hindi version of the Prolonged Grief Disorder-13 Revised Scale (PG-13-R-H) among Hindi-speaking adults in the United States for screening and secondary monitoring.

Methods: A cross-sectional online survey was conducted with 527 Hindi-speaking adults residing in the United States who had experienced bereavement. Participants completed the PG-13-R-H, the Patient Health Questionnaire-9 (PHQ-9), and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Reliability was assessed with Cronbach's alpha, and validity was evaluated using Pearson correlations and a multi-trait-multimethod matrix (MTMM).

Results: The PG-13-R-H demonstrated adequate internal consistency (Cronbach's alpha = 0.75). Overall, 15.6% of participants met diagnostic thresholds for PGD. COVID-19-related deaths were reported by 41.7% of the sample, and 88.6% had experienced an unexpected loss-both strong risk factors for PGD. Convergent validity was supported by correlation with depressive symptoms (PHQ-9; r = .23, p < .001), while discriminant validity was supported by a non-significant correlation with well-being (WEMWBS; r = -.05, p = .34). Findings also highlighted the impact of diaspora mourning contexts, where disruptions in family-based rituals and limited support systems may intensify grief among Hindi-speaking Americans.

Conclusions: The PG-13-R-H is a reliable, valid, and culturally sensitive tool for assessing PGD among Hindi-speaking Americans. This study emphasizes the importance of language-specific and contextually informed assessment tools to identify at risk individuals in diasporic communities, where pandemic-related disruptions and limited support systems may heighten vulnerability to prolonged grief.

Background: Building capacity in primary mental healthcare supports effective task-shifting and sharing. Using technology in this context offers convenience and scalability.

Methods: We describe the methodology of a novel effectiveness-implementation hybrid randomized controlled trial to evaluate the effect of an add-on online mental health training (OMHT) program for primary care doctors (PCDs) on their management of commonly prevalent psychiatric disorders. The comparator was training as usual (TAU).Nine (9) taluks of Tumkur District in Karnataka state were divided into study (SG) and control group (CG) clusters through randomization (SG-6; CG-3). TAU: an annual, in-person training program for 2 days on identifying and treating commonly prevalent psychiatric disorders in the community. was received by all PCDs across the district. An add-on OMHT (12 hours of digital training followed by supportive handholding through Collaborative Video Consultations for 3 months) was provided to the PCDs in SG. Primary outcomes included comparison of diagnostic concordance, treatment concordance, and combined concordance (diagnosis and treatment) between the assessors (research psychiatrists) and PCDs. Secondary outcomes were comparison of (a) short-term clinical outcomes of patients with psychiatric disorders treated by PCDs using standardized scales, (b) implementation questionnaire having a bearing on integrating mental health into primary healthcare delivery systems and (c) procurement pattern of psychiatric medications at Primary Health Centers (PHC) across three phases: 4 months pre-training, training (4 months) and 4 months post training.

Results: The results of this trial are described separately in other articles.

Conclusions: The trial's results shed light on the utility of online training methods for PCDs to hone their skills in primary care psychiatry. It would also provide insights into the implementation barriers and facilitators for capacity-building programs, as well as their translation into clinical practice.

Registration: Clinical Trials Registry of India (CTRI/2024/02/062906).

Background: Training primary care doctors (PCDs) enables them to provide timely and effective treatment of psychiatric disorders in community settings. However, its impact on clinical outcomes remains relatively unexplored.

Methods: This cluster randomized controlled trial compared "Training As Usual" [TAU; 2 days of in-person, lecture-based training; control group (CG)] with TAU plus an 18.5-hour Online Mental Health Training (OMHT; study group [SG]) for PCDs. Clinical outcomes (n = 41; SG = 24, CG = 17) were assessed at baseline and after eight weeks using standardized scales (K10, EQ-5D-5L, IDEAS, CGI-S, BARS) across common (CMDs), severe (SMDs), and substance use disorders (SUDs, including alcohol and tobacco). Both groups completed questionnaires evaluating implementation aspects such as acceptability, adoption, appropriateness, feasibility, fidelity, and provided feedback on training relevance, changes in practice, and operational barriers.

Results: Overall (all disorders put together), significant improvements in subjective perception of health and disease severity were found in both study (EQ-VAS, p < .01; CGI-S, p = .03) and CG (EQ-VAS, p < .01; CGI-S, p = .05), and a reduction in distress score (K10; p = .01) in SG alone. Domain-wise analysis showed significant improvements in K10 (p = .02), EQ-VAS (p = .04), and CGI-S (p = .04) scores only in SG for CMDs. The same was not true for SMDs or SUDs. PCDs reported high acceptability, adoption, and appropriateness (over 90%) for integrating mental health into primary care. However, feasibility (71.4-86.4% citing support systems) and fidelity (only 9% of consultations had psychiatric diagnoses, and just 25% of those received psychotropic prescriptions) were lower. Significant barriers included staff and medication shortages, stigma, and limited mental health awareness.

Conclusions: Training PCDs has the potential to yield significant short-term clinical benefits for individuals with common psychiatric disorders. Supplementary training may provide additional clinical advantages, particularly for CMDs. PCDs identified multiple challenges in incorporating mental health services into primary care practice.

Trial registration: The Clinical Trial Registry of India (Registration No. CTRI/CTRI/2024/02/062906.

Background: Training primary care doctors (PCDs) to manage common psychiatric conditions is seen as a key strategy to reduce the treatment gap, but its effects on their diagnostic and treatment skills remain largely unstudied.

Methods: A hybrid cluster randomized controlled trial compared two PCD training methods: training as usual (TAU; two days of in-person lectures, control group [CG]) versus TAU plus online mental health training (OMHT; 18 hours of interactive modules, study group [SG]). Primary outcomes (diagnostic, treatment, and combined concordance) between PCDs and psychiatrists were evaluated using Cohen's kappa (κ), with group comparisons made via paired t-test.

Results: For identifying anxiety disorders, SG (κ = 0.41) performed better than CG (κ = 0.06; p = .02). Likewise, for somatization disorders, SG had moderate concordance (κ = 0.35), while CG had poor concordance (κ = 0.05; p < .01). For depressive disorders, SG had low concordance (κ = 0.12), while CG showed moderate concordance (κ = 0.58; p < .01). For antidepressant prescription, SG (κ = 0.35) performed better than CG (κ = 0.15; p = .03). Combined concordance for common mental disorders (CMDs) as a domain showed that SG (κ = 0.35) fared better than CG (κ = 0.15, p = .03). Conversely, for severe mental disorders (SMDs), CG (κ = 0.83) performed better than SG (κ = 0.35; p = .03).

Conclusions: Add-on OMHT enhances PCDs' diagnostic and treatment skills for select conditions, particularly anxiety and somatization, highlighting its potential as a scalable model.

Trial registration: The trial was registered with the Clinical Trial Registry of India (Registration No. CTRI/2024/02/062906). https://ctri.nic.in/Clinicaltrials/login.php.