Indian Journal of Psychological Medicine最新文献

Background: For persons with mental illnesses (PWMI), mental capacity (MC) refers to their ability to perceive, choose, and articulate their treatment options. An advance directive (AD) is a declaration stating a person's wishes for care if their mental condition renders them handicapped. It also permits them to designate a nominated representative (NR) to assist them in making treatment-related decisions. The study aimed to ascertain the MC for treatment decisions, including admission of Indian PWMI, and analyze their AD.

Methods: This was a descriptive, exploratory, cross-sectional study involving 74 PWMI. The Clinical Global Impression-Severity (CGI-S) scale, "Capacity Assessment for Treatment Decisions Including Admission," the Bengaluru Advanced Directive Interview (BADI), and the Insight and Treatment Attitudes Questionnaire (ITAQ) were used to assess the severity of illness, MC, AD, and insight, respectively.

Results: The majority of PWMI (N = 66, 89.18%) had MC and were able to make choices regarding their admission, care, and treatment for mental health issues. Twelve patients who did not receive AD for treatment believed that in the future, they would never have any mental illness. The MC was significantly related to gender and insight (p values .020 and .001, respectively). Regarding AD, patients predominantly chose outpatient care (55.38%) and management by psychiatrists (78.38%) over other treatment providers. Mainly, parents (55.4%) were selected as NRs.

Conclusions: The majority of the Indian PWMI had MC and provided AD. The MC was significantly related to insight. According to current regulations, when providing care for PWMI, MC, and AD should be routinely assessed and documented.

Background: Early identification and management are associated with better outcomes for individuals with autism. However, the limited awareness of autism among frontline healthcare workers has led to delays in referrals and diagnoses. This study aims to assess awareness and knowledge about autism among Accredited Social Health Activists (ASHA) workers.

Methods: This cross-sectional study was conducted with 103 ASHA workers in Udupi district, Karnataka, India. A semi-structured assessment was used to collect socio-demographic information and assess basic awareness of autism. Knowledge of autism signs and symptoms was evaluated using items from the Indian Autism Screening Questionnaire (IASQ), which was modified for the study.

Results: Among the participants, 70.5% categorized autism as a mental illness. Additionally, 58.8% identified the earliest age for autism diagnosis as 03 years. Furthermore, 68.2% knew that children with autism require medication alongside other treatment modalities, such as counseling, speech therapy, and occupational therapy. Compared with those without such experience, ASHA workers with prior experience attending lectures on developmental disorders had greater knowledge of identifying symptoms of autism, including social communication deficits and restricted, repetitive patterns of behavior and interest. Three percent of the participants reported no knowledge of autism symptoms.

Conclusion: This study revealed that ASHA workers had limited awareness and knowledge regarding autism, including its symptoms, course, and management. These findings suggest the need for more specific awareness-building programs in addition to existing training programs available for ASHA workers, which might help with the early identification and referral of children with autism for early psychosocial intervention.

This article explains that systematic reviews with meta-analysis (SRMAs) resemble original research in many ways, and should therefore be considered as such in journal listings, for academic appointments and promotions, and for consideration for awards. SRMAs are best conceptualized as a specialized form of original research.

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 article critiques their ethical costs and proposes realistic reforms for inclusive, responsible data collection.

Diversity, Equity, and Inclusion (DEI) are essential for ethical biomedical research, yet gaps remain in the editorial board, peer review, authorship, and research participation. This editorial examines ways to integrate DEI into global biomedical publishing and highlights the initiatives undertaken by various organizations. It addresses challenges such as underrepresentation and exclusionary practices affecting individuals from low- and middle-income countries and marginalized communities. The piece suggests strategies for incorporating DEI into research and publishing while promoting accountability and meaningful change. To develop a biomedical research landscape that is fair and inclusive, it is essential to advance DEI from mere discussion to genuine structural transformation.

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).