Indian Journal of Psychological Medicine最新文献

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.

Background: As more accurate neuromodulation systems combining high-resolution electroencephalogram (EEG) and anatomical biomarkers develop, it is prudent to evaluate how refined and effective precision neuromodulation is compared to conventional techniques. Considering the growing incidence and the lack of studies outlining an optimal treatment approach, which often leads to a poorer prognosis, young-onset mania presents an ideal challenge for such a comparison.

Novelty: This study aims to be the first to directly compare precision and conventional neuromodulation in child and adolescent populations. It also seeks to study and compare, for the first time, changes in neuroimaging parameters caused by precision and conventional techniques. By correlating perturbation-induced changes in cortical inhibition paradigms and functional connectivity of cerebral circuits, we aim to introduce a more objective measure of therapeutic efficacy and response, as opposed to relying solely on subjective clinical scales. Furthermore, we aim to study, for the first time, task-based differential activation of brain areas in young-onset mania.

Methods: Participants would be randomly allocated to the intervention group 1 (G1) or the active control treatment group 2 (G2). Baseline assessments of both groups will include evaluations using clinical scales (Clinical Global Impression [CGI], Brief Psychiatric Rating Scale-Child [BPRS], Young Mania Rating Scale [YMRS], Barratt's Impulsivity Scale [BIS], and Affectivity Reactivity Index [ARI]), task-based and resting-state functional magnetic resonance imaging (rs-fMRI), and transcranial magnetic stimulation (TMS)-based cortical inhibition paradigms (cortical silent period [CSP], short interval intracortical inhibition [SICI], and long interval intracortical inhibition [LICI]). G1 would receive precision-based high-definition transcranial direct current stimulation (HD-tDCS) over the right ventromedial prefrontal cortex (VMPFC) daily for 10 days with 2 sessions spaced 4 h apart. G2 would receive conventional HD-tDCS over the right VMPFC daily for 10 days with sessions spaced 4 h apart. Participants would undergo reassessment at 2 weeks following the completion of 20 sessions, using scales, task-based and rs-fMRI, and cortical inhibition paradigms, as well as at 6 weeks.

Results: Data would be analyzed using the Statistical Package for the Social Sciences (SPSS) for outcome variables as defined for the study. The primary outcome variable would be the improvement in the severity of young-onset mania, as measured by YMRS and CGI scale scores, using precision over conventional HD-tDCS. The secondary outcome would be an improvement in functional connectivity, as measured by neuroimaging, and enhancement of cortical inhibition, as measured by cortical inhibition paradigms, in young-onset mania after receiving adjunctive precision over conventi