Indian Journal of PsychiatryIndian Journal of Psychiatry
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 Table of Contents    
MARFATIA AWARD  
Year : 2018  |  Volume : 60  |  Issue : 5  |  Page : 11
Marfatia Award



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Date of Web Publication1-Feb-2018
 

How to cite this article:
. Marfatia Award. Indian J Psychiatry 2018;60, Suppl S4:11

How to cite this URL:
. Marfatia Award. Indian J Psychiatry [serial online] 2018 [cited 2020 Sep 30];60, Suppl S4:11. Available from: http://www.indianjpsychiatry.org/text.asp?2018/60/5/11/224511




Transcranial Direct Current Stimulation for Refractory Auditory Hallucinations in Schizophrenia: An Open Clinical Trial

P. N. Suresh Kumar1, Arun Gopalakrishnan1, V. Rajmohan2, Chittaranjan Andrade3

1KMCT Medical College, Calicut, 2MES Medical College, Perinthalmanna, Kerala, 3National Institute of Mental Health & Neurosciences, Karnataka, Bangalore, India

Objective: Large number of patients with schizophrenia have auditory hallucinations refractory to antipsychotics. Studies of repetitive transcranial magnetic stimulation suggest that application of transcranial direct-current stimulation (tDCS) with inhibitory stimulation over left temporo-parietal cortex and excitatory stimulation over left dorsolateral prefrontal cortex could affect hallucinations and negative symptoms. The authors investigated the efficacy of tDCS in reducing the severity of auditory hallucinations as well as negative symptoms.

Method: 31 patients with schizophrenia and medication-refractory auditory hallucinations were allocated to receive 20 minutes of active 2-mA tDCS stimulation twice a day on 2 consecutive weeks and followed up for 16 weeks. The anode was placed over left dorsolateral prefrontal cortex and cathode over left temporo-parietal cortex.

Results: Auditory hallucinations were reduced by tDCS with 29% improvement at 2nd week and another 10% improvement between week 2 and 6. The beneficial effect on hallucinations lasted for up to 16th week. The authors also observed amelioration of negative symptoms as measured by the Positive and Negative Syndrome Scale.

Conclusion: Although this study is limited by the small sample size and non-blinded nature, the results show promise for treating refractory auditory hallucinations and negative symptoms in schizophrenia.

Key Words: schizophrenia, auditory, hallucinations, negative

A Study of Clinical and MRI Brain Correlates of Cognitive Impairment in Post-Stroke Elderly Patients

Introduction: Stroke affects 15 million people every year worldwide. Cognitive impairment is an important complication resulting in significant impairment in quality of life. It is important to identify its clinical and MRI brain correlates to prevent cognitive impairment and effective cognitive rehabilitation.

Aims and Objectives: To identify pattern of cognitive impairment across its various domains in post-stroke patients and to find association of cognitive impairment with clinical parameters after stroke and changes seen on MRI brain.

Methodology: 100 elderly patients after a single stroke episode (3 months or prior) were studied. Relation of clinical variables and cognitive impairment using ACE-R scale was noted. Later, a subset of 70 patients who had good pre-stroke cognitive functions and vascular risk factors was identified. Their MRI brain scans were studied and data was analyzed.

Results and Conclusion: Prevalence of cognitive impairment was found to be 78% with highest prevalence in domain of fluency(80%), followed by memory(69%), visuo-spatial orientation(68%), attention(57%) and language(27%). Clinical correlates like duration passed since stroke episode, clinical presentation of stroke, time required for full recovery of deficit symptoms were not associated with cognitive impairment. In the subset of 70 patients, 100% of the patients showed presence of white matter hyperintensities(WMH) on MRI brain scans. General cognitive impairment as seen on total ACE-R score, was not associated with any specific locations of WMH in brain. Specific domains showing significant association included attention and memory with left internal capsule, language with left internal capsule and thalamus and visuo-spatial orientation with right and left frontal lobe and thalamus.

Keywords: Stroke, MRI

Smartphone based solutions for managing severe mental illnesses in low resource settings: roadblocks and opportunities

Deb KS*, Sood M, Chadda RK, Singh P, Verma R, Kumar S, Tuli A, Ganesh R

Assistant Professor Room No: 4096, Department of Psychiatry, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, koushik.sinha.deb@gmail.com

Background: Mobile application based delivery of psycho-social interventions may help reduce treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but suffer from lack of applicability in low resource scenarios due to difference in technology penetration, affordability and acceptance. This study aimed to understand the health technology usage, perceived needs and acceptability of app based interventions in patients of SMIs and their care-providers.

Materials and methods: The study was conducted in the inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed the smartphone and health app usage. Three focused group discussions evaluated needs and apprehensions in using apps in management of SMIs. Health technology acceptance was assessed by in-depth interviews in patients and their care providers after 15 days of app use.

Results: Around 34% of the 88 patient-caregiver pairs surveyed had access to smartphones, although health app usage was low. Cost, unfamiliarity, and language were significant barriers to adoption. Actual app usage was hampered by low technology literacy.

Conclusions: The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings.

Keywords: smartphones, apps, SMI, schizophrenia, bipolar disorder, health technology

Acceptability and Feasibility of Tele-psychiatric “On-Consultation Training” Program for Primary Health Care Physicians

BR Kiran, Virupakshappa I Bagewadi, Karishma Kulkarni, Shyam RPS, Vinay Gowda,HN Shashidhara, N Manjunatha, Rajani Parthasarathy*, C Naveen Kumar, Suresh Bada Math, Jagadisha Thirthalli

Department of Psychiatry, NIMHANS Bengaluru, *Department of Health and Family Welfare, Government of Karnataka

Background: The essence of successful integration of psychiatry into the primary care is empowerment of Primary Care Physicians (PCPs). Tele-psychiatric On-Consultation Training (Tele-OCT) where specialist psychiatrists assist PCPs in managing psychiatric cases in one effort for the same. This Tele-OCT program began at Mandya district of Karnataka and recently completed 100 hours of training involving 34 PHC doctors.

Aims: to study the acceptability and feasibility of Tele-OCT among PCPs as well as by tele-psychiatrists.

Methods and Material: Training was conducted through video-conferencing. Routine patients attending OPDs were the recipients of care. Clinical Schedules developed by the authors was used for assisting consultation and management. Feedback was collected in a semi-structured questionnaire from participant PCPs and Tele-psychiatrists. Mean and Standard-deviation of the feedback scores were analyzed.

Results: Majority of the feedback scores obtained from the PCPs and also tele-psychiatrists were in favourable range suggestive of good acceptability and feasibility.

Conclusions: Tele-OCT demonstrates that it is both acceptable and feasible both from PCPs and tele-psychiatrists. It’s potential in overcoming barriers of integrating mental health in primary care needs to be explored in larger scale.

Key words: Telemedicine, Mental health , Primary care, Training, Feasibility and Acceptability



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