Indian Journal of Psychological Medicine最新文献

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.

Purpose of the review: There is a dearth of research on determining the optimal psychological intervention approach for symptom-specific management in schizophrenia. Hence, the current study aimed to assess the efficacy of therapeutic strategies in the management of various symptom subtypes, such as positive symptoms (PS) and negative symptoms (NS), hallucinations, and delusions in schizophrenia.

Collection and analysis of data: Six electronic journal databases, namely Web of Science, Scopus, EBSCOhost, PubMed, Ovid, and Taylor and Francis were searched up to November 2023 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Network Meta-Analyses (NMA) guidelines. Articles were identified using predefined keywords and subsequently screened by pre-specified inclusion and exclusion criteria. Data from the included randomized controlled trials (RCTs) were extracted for PS, NS, hallucinations, and delusions, both for pre- and post-trial conditions. The effect size and standard errors of each trial were computed using the "metafor" library, and further NMA was performed using the "netmeta" package of R software version 4.2.1. The analysis was conducted on 100 RCTs involving 7,036 patients with schizophrenia undergoing eight different psychological interventions and treatment-as-usual (TAU). Meta-cognitive training (MCT+), social skills training (SST), cognitive behavioral therapy (CBT), and cognitive remediation therapy (CRT) were found to be effective in treating both PS and NS of schizophrenia. However, virtual reality therapy (VRT) was found to be effective only in the management of hallucinations and overall PS, and MCT+ and CBT were found to be effective treatment measures in the management of delusions.

Conclusions: Psychotherapies were found to be more effective compared to TAU, except acceptance and commitment therapy (ACT) and supportive psychotherapy (ST).PROSPERO Registration ID: CRD42022385392.

Background: The increasing emotional distress among emerging adults highlights the importance of examining trauma-related factors, particularly complex trauma. This study investigates post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (C-PTSD), and emotional distress, emphasizing the predictive role of disturbances in self-organization (DSO) as defined by the International Classification of Diseases (11th revision) (ICD-11).

Methods: A cross-sectional study was conducted among 538 college-going emerging adults (aged 15-29 years). The study received ethical clearance from the institute and informed consent from the participants, who completed validated measures: the International Trauma Questionnaire and Depression, Anxiety, and Stress Scale-21. Quantitative data were analyzed using descriptive statistics, Mann-Whitney/Kruskal-Wallis tests, Pearson's correlation, and multiple linear regression. Thematic analysis was used to explore self-reported traumatic experiences.

Results: Prevalence rates were 15.2% for C-PTSD, 20.8% for PTSD, 53.9% for depression, 66.5% for anxiety, and 36.2% for stress. DSO showed the strongest associations with all three domains of emotional distress. Thematic analysis revealed multidimensional trauma themes, including career anxiety, relational issues, abuse, loss, and social exclusion. Gender and psychiatric history significantly moderated distress levels, while rural-urban background showed no difference.

Conclusions: Among the variables, DSO demonstrated the strongest and most consistent associations with depression, anxiety, and stress, pointing to its close link with complex trauma responses. Results highlight the need for trauma-informed screening and interventions in Indian academic settings and support ICD-11's distinction between PTSD and C-PTSD. A tiered intervention model is recommended for early detection and tailored care.

Background: This study evaluated intramuscular (IM) ketamine's efficacy and safety for rapid suicidal ideation reduction, addressing the critical need for fast-acting interventions in resource-limited settings where intravenous (IV) options are impractical.

Methods: We conducted a pre-post-interventional study of IM ketamine (0.5 mg/kg) over one year after approval of the institutional ethics committee. Adult patients with suicidal ideation, as measured by the six-point Montgomery-Åsberg Depression Rating Scale-Suicidal Ideation (MADRS-SI), were included if their MADRS-SI score was >4. Post-injection monitoring of suicidal ideation and adverse effects (A/E) was done after two hours and on Days 1, 3, 7, 14, 21, and 28. A repeat injection of the same dose was given only if the MADRS-SI score became > 4 again. The paired-T-test and repeated-measure ANOVA test were used for statistical analysis.

Results: Thirty-eight patients (mean age: 36.3 years) participated, with 66% diagnosed with major depressive disorder and a mean MADRS-SI score of 5.31. At two hours post-injection, the MADRS-SI score decreased by 4.13 points (78% reduction), with 76% (N = 29) of patients reporting no suicidal ideation (score 0-1). Of the 28 patients who completed a one-month follow-up, 89% (N = 25) maintained a reduction in suicidal ideation (mean reduction: 4.75 points). A total of 64% (N = 16) required only one injection, while 36% required multiple injections. Three patients did not recover even after six trials of ketamine. Among 21 patients who completed six months of follow-up, 8 (28%) patients had relapsed. A/E was reported in 87% of patients, with dizziness and sedation being the most common (57%). No serious or life-threatening adverse effects were noted.

Conclusions: IM ketamine (0.5 mg/kg) is effective and safe for the rapid reduction of suicidal ideation.