Indian Journal of Psychological Medicine最新文献

Background: Transcranial electrical stimulation (tES) is a non-invasive neuromodulation technique increasingly recognized for its therapeutic potential in psychiatric disorders. Recent advances have enabled its administration in home settings, potentially increasing accessibility, reducing costs, and overcoming logistical barriers to in-clinic care. This scoping review systematically maps the preliminary evidence on home-based tES interventions for psychiatric disorders, while also assessing their feasibility, safety, and methodological trends.

Collection and analysis of data: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a comprehensive literature search in PubMed and Scopus, covering publications from 2000 to 2024. Eligible studies examined the use of home-based tES (transcranial direct current stimulation [tDCS], transcranial alternating current stimulation [tACS]) for the treatment of psychiatric disorders. Extracted data included study characteristics, stimulation protocols, monitoring approaches, outcomes, and reported challenges. Forty-three studies met the inclusion criteria, comprising 19 randomized controlled trials (RCTs), 12 open-label studies, and 12 case series or case reports. These studies encompass various psychiatric conditions, with depressive disorder and mild cognitive impairment/dementia being the most frequently investigated. The majority of the studies utilized tDCS, often with remote supervision or digital support.

Conclusions: Our review suggests high feasibility, good adherence, and minimal adverse effects, with potential symptom improvement across various disorders. However, small sample sizes, heterogeneity in protocols, and limited long-term data restrict the generalizability of results. Larger, methodologically rigorous trials are needed to establish efficacy, optimize stimulation parameters, and inform standardized guidelines for safe at-home tES use. Integration with telehealth systems and digital therapeutics may further enhance its scalability.

Background: Pornography addiction is a growing public health concern worldwide, with increasing recognition of its prevalence and consequences in India. This study explores the onset, manifestation, and impact of pornography addiction within the Indian context, addressing the need for culturally relevant research.

Method: A retrospective, observational, cross-sectional study was conducted using data from 589 individuals who sought treatment for pornography addiction through online and offline healthcare platforms. Patients aged 18 and older were included based on the International Classification of Diseases, 11th Revision (ICD-11) diagnostic criteria for Compulsive Sexual Behavior Disorder (CSBD) (6C72). Data on demographic factors, clinical diagnoses, and treatment outcomes were analyzed using International Business Machines Statistical Package for the Social Sciences (IBM SPSS). Participants received either pharmacological treatment, psychotherapy, or a combination of both.

Results: The sample included 589 participants, predominantly male (n = 583; 98.98%), with a mean age of 28.98 years; 374 (63.5%) were under 30, and 287 (48.7%) were single. Most identified as heterosexual (n = 568; 96.4%) and had no prior treatment history (n = 465; 78.9%). Common co-morbid sexual dysfunctions included erectile dysfunction (n = 232; 39.4%), premature ejaculation (n = 198; 33.6%), and low sexual desire (n = 109; 18.5%). Pharmacological treatment was most common (n = 338; 57.4%), followed by psychotherapy (n = 207; 35.2%) and combined treatment (n = 44; 7.4%). Age showed significant associations with addiction severity (χ² = 17.07, p = .01), relationship status (χ² = 190.11, p < .01), and treatment modality (χ² = 12.25, p = .01), with younger individuals more often receiving psychotherapy. Severity was weakly but significantly correlated with both age (r = 0.149, p < .01) and number of psychiatric diagnoses (r = 0.098, p < .05).

Conclusions: Pornography addiction in India is shaped by age, relationship status, and cultural context. These findings underscore the need for age-targeted, culturally informed interventions. Future research should examine longitudinal trends and psychiatric comorbidities to guide comprehensive treatment planning.

Background: Specialist services, such as geriatric psychiatric clinics, aim to provide a multi-disciplinary and person-centred approach. There is not enough information available about the number and type of such clinics in India. In this descriptive article, we aim to detail the services provided and the socio-demographic and clinical characteristics of patients who have attended a geriatric psychiatry outpatient clinic in southern India.

Methods: A specific data sheet was used to record the socio-demographic and clinical details of patients attending the weekly geriatric psychiatry outpatient clinic at the Institute of Mental Health and Neurosciences, Kozhikode. The clinic uses comprehensive proformas and assessment tools as appropriate. The Short Assessment of Patient Satisfaction scale was used to assess satisfaction with the services.

Result: Between August 2023 and March 2024, 80 patients attended the geriatric psychiatry outpatient clinic. Men and women were equal in numbers (40, 50%). The mean age of the attendees was 68.91 (SD = 6.87). Sixty-four (80%) patients had co-morbid medical disorders. The most common psychiatric diagnosis was dementia and adjustment disorder (14; 17.5%). Eight (10%) patients each had depression and anxiety disorders. Regarding treatment, 48 (60%) were prescribed psychotropic medications: 21 (26.3%) were on antipsychotics, 37 (46.3%) were on antidepressants, and 14 (17.5%) were on benzodiazepines. Most patients were 'very satisfied' with the service, 47 (58.8%) scoring 27 or 28 on SAPS, where the maximum score is 28.

Conclusions: A multi-disciplinary team ensures effective, holistic geriatric psychiatric care. High patient satisfaction highlights the importance of structured, person-centred approaches in mental health services for older adults.

Background: Mental health disorders are a common cause of disability worldwide. Disparities exist between the mental health frameworks of high-income countries (HICs), upper middle-income countries (UMICs), and low- and middle-income countries (LMICs). LMICs have shortages in infrastructure, financial resources, laws, and workforce, resulting in significant gaps in treatment. This study compares mental health system indicators across 10 nations to examine how economic and policy-level factors influence service access and population-level burden.

Methods: A cross-sectional comparative analysis was conducted using publicly available secondary data. Sources included the WHO Mental Health Atlas, World Bank Open Data, Global Burden of Disease (GBD), and national mental health policies. Five HICs (United States, United Kingdom, Germany, Australia, Japan) and five UMICs plus LMICs (Brazil, South Africa, India, Kenya, Nigeria) were selected. Mental health budget allocation, treatment gap, psychiatrist density, psychiatric bed availability, primary care integration, and disability-adjusted life years (DALYs) were assessed. Descriptive statistics and Pearson correlations were applied.

Results: HICs allocated 6.1%-11.3% of health budgets to mental health, had lower treatment gaps (19%-32%) and higher psychiatrist densities (11.8-14.6/100,000). On the contrary, LMICs had a budget share below 1%, treatment gaps >75%, and psychiatrist densities <1. A strong positive correlation was observed between GDP per capita and the prevalence of psychiatrists (r = 0.77, p < .001), and a strong negative correlation was observed between the gap in treatment and the share of the budget (r = -0.82, p < .001).

Conclusions: Economic capacity and political commitment have a substantial impact on mental health systems. Strengthening the workforce, integrating services, and reforming legislation are essential to closing the gaps in treatment and achieving equity.