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|Year : 2016
: 58 | Issue : 5 | Page
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. Symposia. Indian J Psychiatry 2016;58, Suppl S1:10-40
Experiences from the interface between Law and Psychiatry in the United Kingdom
Advance Decisions; Testamentary Capacity; Capacity Act (England and Wales) and Human Rights Act and their implications to clinical practice'.
Seshagiri Rao Nimmagadda*, Srinivas Suribhatla, D M Michael, Santosh Mudholkar
*Department of Forensic Psychiatry, Thornford Park Hospital, Priory Group, UK
Background: The Human Rights Act enshrines (HRA 1998) individual's human rights e.g. right to life, right to a fair trial etc. and The Mental Capacity Act (MCA 2005) consolidates these principles for people who may lack the capacity to make their own decisions. MCA promotes the empowerment of individuals and the protection of their rights.
Objectives and Methods: This presentation will begin with a review on the elements of Human Rights which have a special relevance to Mental Health. The second part of this review will examine literature and the evolution of UK legislation from 19th century 'legally correct and only test' for testamentary capacity outlined in the 19 th century Banks v Goodfellow judgment to current day The Mental Capacity Act. The presentation will introduce the concept of mental capacity and summarise the principles regarding assessment of mental capacity and best interest decision making. These concepts will be explained with case vignettes regarding dementias and functional mental health problems. The third part of this review will explore testamentary capacity, which usually arises within the context of the execution of a Will or a Trust or Advance Decisions. We will explore why the requirements for testamentary capacity are minimal; 'Golden Rules' to be followed to avoid the claim of 'vulnerability to undue influence', during posthumous psychological reconstruction of evidence and forensic evaluation.
Conclusions: The presentation will conclude with a summary of inter-relationship between The Human Rights Act and The Mental Capacity Act; Indian experience of challenges in upholding human rights after the world's worst industrial disaster in 1984 in this very city Bhopal; and how communities and countries can learn from each other's experiences.
Keywords: Testamentary, Law and Psychiatry, Human rights, Mental capacity Act
Training and Working in the UK: Optimising Success for International psychiatrists
Sab Bhaumik*, Subodh Dave, Donna Arya, Aofie Singh,
*OBE, Hon. Fellow, Royal College of Psychiatrists
National Health Service (NHS) in the UK is one of the largest employers in the world and widely regarded as the best health system in the world. NHS has welcomed medical and healthcare staff from all over the world and of the 150,000+ doctors in the NHS, 40% are from outside the UK. It is estimated that the NHS employs over 5000 international psychiatrists!
With a range of sub-specialties (child psychiatry, old age psychiatry, forensic psychiatry) training in the UK offers unparalleled experience of working in sophisticated multi-disciplinary teams focused on patient safety and improving patient outcomes.
This session will provide an update on the opportunities available to work and train in the UK.
- Medical Training Initiative: Trainees are able to train in the UK for up to 2 years without the need to do the PLAB exam provided they are successful in a competitive interview conducted by RCPsych.
- For a limited period of time, international psychiatrists are also able to apply for core training in psychiatry and as non-training doctors or Consultant grade doctors in Old Age Psychiatry. Changes in UK Border Agency rules mean that non-EU citizens can apply to these jobs on par with local UK doctors. Successful applicants will therefore be able to get a Tier 2 visa to work in the UK.
The session will focus on providing practical information on working and training in the UK. Critically, the session will cover issues relating to professionalism and quality standards of routine clinical care that feature in recruitment interviews and in the MRCPsych exams. International applicants generally tend to do less well on these elements and the session will provide guidance in optimizing performance in these areas.
Keywords: PLAB, RCPsych, National Health Services
Alcohol Related Dementia - Diagnosis and Treatment
*Consultant Old Age Psychiatrist and Training Programme Director, Leicestershire Partnership NHS Trust and Health Education East Midlands UK.
Background: Excessive and prolonged alcohol use can lead to permanent damage to the structure and function of the brain but the diagnosis of alcohol related dementia is often based on clinical judgement due to lack of objective diagnostic criteria. The vast majority of people with a long history of alcohol misuse, one of the top ten risk factors for mortality and morbidity, do not develop the typical symptoms of Wernicke-Korsakoff syndrome or full blown alcohol related dementia.
Objectives and Methods: This presentation will begin by reviewing literature and examining the extent of Alcohol misuse and dementia, putative mechanisms linking the two conditions including benefits of limited drinking in earlier adult life and harmful effects of long-term alcohol consumption. We will explore relationship between Alcohol related Dementia and Wernicke- Korsakoff's syndrome.
Conclusions: We will examine neuropathology, neuropsychology, clinical considerations and recommendations for diagnostic imaging and management.
Keywords: Alcohol, Wernicke- Korsakoff's syndrome, Alcohol related Dementia
Technological Addiction Across Generations, Neurobiological Correlates and Management of Technological Addiction
Ranjan Bhattachryya*, Malay Kumar Ghoshal, Kaustav Chakraborty, Supriya Kumar Mondal
*Department of Psychiatry, Murshidabad Medical College & Hospital, West Bengal, E-mail: [email protected]
Background: A list of modern day gadgets is exhaustive that includes Laptop, Desktop, iPad, iPod, Video games, Mobile phones especially smart phones, games and applications etc. The various pattern of technological addiction is increasing day by day as these devices are getting popular and becoming a 'status symbol' in modern life.
Aims and objectives: People are enjoying a virtual world and feeling of togetherness in day long busy schedule, taking a break off or in leisure time people are using social media very often. Narcissism in subconscious level or a way to show chivalry to subordinates or a media to explore business communication is increasing the technological addiction need to be studied in asystematic manner.
Neurobiology: There are different types of impulsivity with different significance and different cerebral correlates. One of the networks which is active in resting state is default mode network (DMN) consisting of PCC, precuneus, medial prefrontal cortex and bilateral temporoparietal junction.
Management: Though MET remains a cornerstone for treatment of drug addiction, its applications in IA have been sparse. The inpatient internet addiction recovery intervention in Washington is popular as reSTART program. Cognitive behavioural therapy has been modified to treat Internet addiction. There are studies claiming benefits by Escitalopram, other antidepressants, or mood stabilisers. One study claims electric shocks on un-anaesthetised Internet addicts as part 'holy crusade' to cure Internet addiction. Cognitive behavioural therapy has been modified to treat Internet addiction. Intervention with family members or other relatives like 'Community Reinforcement and Family Training', couple therapy could be useful. In China there is even a half-way house for adolescents with Internet addiction.
Conclusion: Addiction to modern gadgets and technologies generates wide range of problematic behaviours including excessive use of social networking sites (SNS). Total abstinence from the Internet use should not be the goal of the therapeutic interventions. Pharmacological management includes use of Antidepressants (SSRIs, venlafaxine, bupropion), Mood stabilizers (lithium,divalproex etc), Anxiolytics, Naltrexone etc. The effective non pharmacological management comprises Cognitive behaviour therapy, Family therapy, Marital therapy, placement in Support groups and Half-way home.
Keywords: Technological addiction, reSTART program, MET, Internet addicts
Challenging Issues of Benzodiazepines Prescriptions in Elderly
Gauri Shanker*, Prabhu Dayal, Yadav J S, Namita G, Kaur S
*Department psychiatry and NDDTC, AIIMS New Delhi, E-mail: [email protected],
There is a wide divergence between published guidelines and clinical practice on benzodiazepine prescriptions, the guidelines says that this should only be prescribed for maximum of 2-4 weeks, but in many cases it prescribed for longer durations. In several studies it was found that benzodiazepines associated with increased delirium in elderly, the other causes associated with durations of delirium are pre-existing dementia, receipt of neuroleptics, and severity of illness. The number of people taking prescribed benzodiazepines worldwide is enormous and over 1 million people in the UK are on long-term. Up to half of long-term users have difficulties in stopping benzodiazepines because of withdrawal symptoms. The rate of development of tolerance may vary with different drugs, relief of anxiety, sedation and pleasure, it can also develop at different speeds, and can vary between individuals. Rapid-onset drugs are associated with 'good' subjective feeling and therefore result in psychological reinforcement every time they took in higher dose. Benzodiazepines bind to receptors on the GABA-A receptor complex and can directly or indirectly affect almost every part of brain function unselectively. This "inhibitory" effect is responsible for the characteristic effects of sedation, amnesia and motor incoordination. A UK study showed that 75% of patients reported sleep disturbance symptoms lasting a year, and chronic insomnia increasing upto 12-25% in patients over 60 years of age (Morphy, Dunn et al. 2007; Montgomery and Shepard 2010). Cognitive behavioural therapy (CBT) is an effective treatment in mild to moderate sleep disorders performed either individually or in small groups but besides focus on CBT many clinicians prescribes benzodiazepines in all subtypes. Now the major issues associated with benzodiazepines prescriptions are not for certain indications like anxiety, stress or sleep disorder but it is common practice of benzodiazepine prescription at those places where simple sleep hygene or psychotherapy/behavior herapy can works, therefore In the majorities of such prescriptions patient self medicates and becomes dependent. Though tappering of doses of benzodiazepines is time taking process and substitution with other non addictive neuroleptics leads to poor sence of wellbeing. Therefore the orientation of both prescribers and patients are more towards increases of benzodiazepines doses, the impacts of these practices becomes more problematic specially in advancing age. The aim of presentations of this symposium is to highlight these issues and discus the probable solution.
Keywords: Benzodiazepines, elderly, clinical practice, Cognitive behavioural therapy
Dignity in Mental Health in India
Bhavesh M. Lakdawala*, Naresh Nebhinani, Suneet Kumar Upadhyaya
*Department of Psychiatry, GMERS Medical College and General Hospital, Gandhinagar. E-mail: [email protected]
Objectives: Many people with mental health disorders around the world are deprived of their human rights. They are not only discriminated against, stigmatized and marginalized but also subject to emotional and physical abuse in both mental health facilities and the community. Poor quality care due to a lack of qualified health professionals and poor facilities leads to further violations.
The objectives of this symposium are (1) To understand Stigma and Mental Health Literacy and its Indian status (2) Recent Research and work on Stigma and Quality Care in India and (3) What needs to be done to reduce Stigma and to provide Quality Care
Description: Many studies have shown that negative attitudes towards mental illness are widespread. Several studies report that stigma is universal and involve not only lay persons but also various health professionals including psychiatrists, nursing personnel and health workers. Stigma and discrimination associated with mental illness and the same expressed by mental health professionals as well as the general public, results in the underuse of mental health services. The main strategies for addressing psychiatric stigma and discrimination focus on protest, contact and education.
This symposium is divided into the followings subsections (1) Status of Stigma and Mental Health Literacy in India (2) Research work on Stigma and Quality Care in India (3) Ways of Reducing Stigma and Improving Quality Care
Keywords: stigma, mental health literacy, quality care.
Enhancing Medication Adherence using Information Technology
Siddharth Sarkar*, Naresh Nebhinani, Vikas Menon
*Department of Psychiatry and NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi
Despite efficacious medications being available for the treatment of psychiatric disorders, adherence to medications remains a pertinent clinical problem. Often, patients discontinue medications which may lead to relapse of symptoms of the psychiatric disorder. Hence, improving and ensuring medication adherence remains a thrust area in the clinical care of patients with psychiatric illnesses. Advances in information technology offer some potential for improving medication adherence among patients with psychiatric disorders. The growing penetration of mobile phones among the masses in India offers this as a particularly lucrative option for enhancing medication adherence. This symposium aims to explore the various ways in which information technology can be helpful in optimizing medication adherence. The symposium will explore both the existing technology that has been demonstrated benefits, as well as those which are in the pipeline. The symposium will cover smartphone-based mobile interventions, text reminders, interactive voice response systems, and computer based techniques for improvement of medication adherence. The symposium will also cover information-technology led methods to monitor adherence to psychotropic medications. The evidence base of the information technology based interventions for enhancing adherence would also be discussed. The complementary nature of information technology based interventions as an adjunct to other adherence promotion measures will be discussed. The limitations of these interventions in the present day context would be discussed, as would the scope for future research in the field.
Keywords: Information technology, medication, adherence
Abnormal Movements in Patients with Schizophrenia
Vivek Kirpekar*, Sudhir Bhave, Rahul Tadke, Sushil Gawande, Abhijeet Faye
*Department of Psychiatry, N.K.P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Hingna Road, Nagpur, E-mail: [email protected]
Patients with Schizophrenia are susceptible to have various other problems which includes neurological, systemic and treatment related phenomena. Schizophrenia nowadays has been considered to be a disorder with neuro-developmental origin. Abnormal movements of various types are present in patients with schizophrenia, as a part of the illness or due to the side effects of ongoing psychiatric medications. Many a times these movements are troubling and disabling to the patients. A careful analysis of abnormal movements in patients with schizophrenia will give better insight into this aspect and help in subsequently reducing the morbidity and disability in them.
The present symposium aims at discussing various types of abnormal movements present in patients with schizophrenia, present as part of illness or side effect of ongoing pharmacotherapy. Detail clinical evaluation and assessment with the help of assessment tools will be discussed. This will also be explained with help of a clinical case vignette. The findings of ongoing research related to this phenomenon will be discussed. The approach to diagnosis and role of investigations will be discussed. Management of abnormal movements and current guidelines will be discussed in-depth. Then the authors will speak on the monitoring of the patients in follow up or maintenance phase including those specific for the pharmaco-therapies going on and share the updates available in the medical literature. In the end there will be guidance on dos and don't related to evaluation and management of abnormal movements.
At the end of the symposium the participating delegates will be able to get idea about various clinically relevant aspects of abnormal movements in patients with schizophrenia, the minimum necessary evaluation which should be periodically carried out and various investigations and treatment protocols in acute as well as in maintenance phase.
Keywords: Schizophrenia, morbidity, disability
How to Carry Out and Publish Research
Ajit Avasthi1, Sandeep Grover, Adarsh Tripathi
*Department of Psychiatry, PGIMER, Chandigarh. E-mail: [email protected]
Design: Interactive: This workshop is targeted for the Post-graduate trainee residents and for psychiatrists who are interested in carrying out research. The workshop will focus on how to formulate a research question, how to design research, what are different research designs, literature search to know what is known on the topic, how to write a research proposal, choosing appropriate scales, issues of ethical clearance and informed consent, collection of data, analysis of the data, interpretation of the results, writing the results, writing a manuscript, choosing a journal, submission of manuscript, responding to the comments of the reviewers, handling rejection. The workshop will also touch upon the issue of mentorship.
Keywords: Publish, Research, manuscript
Obsessive Compulsive Symptoms in Patients with Schizophrenia
Ajit Avasthi*, Sandeep Grover, Subodh BN
*Department of Psychiatry, PGIMER, Chandigarh
Initially it was thought that Obsessive compulsive symptoms are rare in patients with schizophrenia and when ever present were considered to be an indicator of good prognosis. However, in recent times, many studies have reported that OC symptoms are common among patients with schizophrenia and the reported prevalence varies from 20-50% and presence of OC symptoms among patients with schizophrenia are associated with poor prognosis. Further recent data suggests that OC symptoms can be considered to be part and parcel of schizophrenia, can be considered as an independent comorbid condition or may be related to use of antipsychotic medications. Understanding of OC symptoms among patients with schizophrenia can have management implications in terms of choosing various antipsychotic medications.
Keywords: OC, Obsessive compulsive symptoms, antipsychotic
Neuro economics and Psychiatric Disorders
Dinesh Kumar MK*
*Malabar Medical College, Modakkallur, Calicut, E-mail: [email protected]
The challenge to neurosciences is the lack of single unifying theory of brain function. The anxiety disorders are explained in terms of conditioning paradigm, the Unipolar depression in terms of Neuroplasticity, Schizophrenia in terms of Network dysfunctions. The above limitations has its impact on our understanding of mental illness and creates a vast chiasm between the clinical presentation and management of mental illnesses. Neuroeconomics a new theory which tries to explain the functioning of brain in terms of economic parameters may guide us to another way of looking at the mental activities. The Neuroeconomics as a subject belongs to the System Neurosciences and to the division dealing with Decision Making. The Neuro economic model has been well established in understanding drug addictions. This model can also be extended to Negative Schizophrenia, OCD, Personality disorders, Autism and other major psychiatric disorders. The emerging field has some illustrious researchers who have contributed for its advancement. The prominent among them being Wolfram Schultz (Temporal difference Learning), Donahue. And Paul Glimcher. Skeptics often wonder how diverse fields as economics and neurobiology can be unified. The arguments of the researchers in the Field of Neuroeconomics have clearly laid to rest those doubts. Neuroeconomics can help us in explaining the mechanisms of major diseases as already mentioned, further on the long run will help us in classification of disorders. Importantly, Neuroeconomics can find new research paradigms(Game theory),(Risk Aversion) and other tools which may help us in understanding the way brain acts in Social situations. Ultimately, the approach can help us find newer treatment possibilities for mental illnesses.
Keywords: Neuroeconomics, Unipolar depression, Neuroplasticity
Regeneration of Mind and Brain
*Psychiatrist, Mental Health Care Centre, Kolkata and Burdwan
In spite of better understanding of brain physiology in the last 25 years, the fact remains that psychiatric illnesses are on increase and we have not made any strong headway in preventing these illnesses. All serious psychiatric illnesses from depression to schizophrenia to dementia have neuronal degeneration in different areas of brain. Increased levels in oxidative stress, mitochondrial dysfunction, excitotoxicity, inflammatory changes, iron accumulation, and protein aggregation are some of the common ways in which neuronal degeneration occurs. For neuroprotective treatment you need to focus on these pathologies. With new methods in basic neuroscience we have improved our understanding of neurodegeneration and loss. Natural methods, like life style changes and drugs which can alter the health of neuronal tissue have been worked upon and some important clues have been found. Over-excitation of glutamate receptors, specifically NMDA receptors, glutamate antagonists, antioxidants, BDNF and other neurotrophin family of growth factors and the latest, Insulin receptors have increased our understanding of molecular psychiatry. As more data accumulate time will be ripe to translate these understanding into bedside wisdom. So let us delve into these areas of understanding and come out with some pearls which improve our day to day understanding of these illnesses and make us better equipped in helping these patients.
Keywords: brain physiology, Regeneration, NMDA, BDNF, neurotrophin
Evaluation and Management of Aggression in Psychiatry Setup
Kshirod K Mishra*, Sushil Gawande, Vivek Kirpekar
* Department of Psychiatry, MGIMS, Sewagram, E-mail: [email protected]
Objective: We intent to provide every update on the neurobiology, evaluation, and management issues in relation to aggressive patients in a psychiatry setup.
Brief Description: Aggression and violence are often used interchangeably though both are not synonym. Violence is a subtype of aggression. Approximately 1.6 million people lose their life worldwide due to violence each year. Aggression encompasses violence in addition to non accidental property destruction and verbal abuse during the period of agitation. Self injurious behavior and suicide are also sometimes classified under the broad rubric of aggression. Each aggressive act of psychiatry patient can be impulsive, organized, or psychotic depending upon the primary diagnosis. We intent to give a brief overview of this common psychiatric emergency which everyone of us face during our day to day practice.
Keywords: Aggression, violence, psychiatric emergency
Challenges and Issues in Managing Involuntary Admitted Patients
N. Prasanna Kumar, R. Anitha, P. Srilakshmi, M. Gireesh Kumar, Ch.Siva Kumar
Department of psychiatry, Institute of mental health and Osmania Medical college, E-mail: [email protected]
Wandering lunatics and persons involved in crimes referred by magistrates, jail superintendents comprise majority of involuntary admissions. These persons are prone to diagnostic dilemmas and uncertainties in treatment due to lack of reliable of information. Issues involving human rights should be taken into consensus while giving treatment. There may be changes in the issues from Mental health act to Mental health care bill. Personality disorders, psychosis, malingering, substance abuse, sexual offending comprise majority of disorders and they are challenges for treating Psychiatrists.
So, the present symposium aims at discussing the diagnostic dilemmas and issues in managing involuntary involuntary admitted patients.
Keywords: Mental health act, Mental health care bill, involuntary admissions.
Difficult to Treat patients in Clinical Psychiatry
Uday Chaudhuri*, Rudraprasad Acharya, Devashish Konar
*Department of Psychiatry, VIMS, KOLKATA, E-mail: [email protected]
In our day to day clinical practice, we come across one or two out of ten patients who are difficult to diagnose.
Our study circle, Kolkata where 15 to 20 psychiatrists meet once in a month since 2007 to share our views, discuss clinical cases difficult to treat as well as interface learning in psychiatry with other branches of medical science & basic sciences. We will present in this workshop some of our cases for the learned participants. We are sure it will ignite their mind for the cause of their patient care and it will be a good learning exercise for all.
Diagnostic Dilemmas in Clinical Psychiatry - Medical Cases Masquerading as Psychiatric Illnesses and Vice Versa
Ishan Chaudhuri*, Shivaji Marella, Adnan Kadiani, Ekram Goyal
* Dept of Psychiatry.Dr DY Patil Medical College, Pimpri. Pune
Objective: In day to day clinical practice, one comes across patients who are difficult to diagnose. The goal of this workshop is to demonstrate how psychiatrists wrestle with diagnostic dilemmas and treatment approaches, often where evidence-based guidance from literature is limited
Brief description: The practice of psychiatry affords an exciting opportunity to learn from the patient. The patients' observations and descriptions are invaluable information that contributes to our understanding of human behaviour. At times however, the clinical picture may be confounding because of the presence of multiple medical co-morbidities. The same will be presented and discussed.
Keywords: Diagnostic Dilemmas, masquerading, Psychiatric illnesses
From Outer to Inner Space: Space Psychology & Nano-Psychiatry
Kalpana Srivastava*, Jyoti Prakash
*Department of Psychiatry, Armed Forces Medical College, Pune. E-mail: [email protected]
Objective : We would like to critically analyse the recent advances in psychiatry which explores the world beyond earthly existence as well as the marvel of nano-particles which modifies our inner space.
Brief Description: Technological advances today has made explorer curious beyond the canvas of earth to the outer space. However will the mind and body behave similarly or show unexplored aberrations. Simultaneously at the other extreme despite so much of technological advancement we have been unable to unravel the complexities of mind. Will the nano-technological revolution explores new arena in evaluation, diagnosis and management of the mentally ill. The symposium today will take a look at both outer and the inner space for better awareness and future readiness.
Keywords: Space Psychology, Nano Psychiatry, inner space
New Psychoactive Substances (NPS): Current Scenario and Future Threats
Debasish Basu*, Abhishek Ghosh, Siddharth Sarkar
*Drug De-addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, E-mail: [email protected]
Background: "New psychoactive substances" (NPS) is the term which encompasses a huge rubric of chemicals with pharmacological properties and clinical effects resembling a known illicit substance. NPS are still elusive to the legal watchdog agencies and thus extremely difficult to be brought under legal proscription. During 2014, 57 psychoactive substances were officially notified for the first time in the European Union (EU). Since then the EU's early warning system has updated the list on a number of occasions, the latest number being 101 as per its March 2015 update. NPS are classified into five categories: ketamine, piperazines, synthetic cathinones, synthetic cannabinoids, and plant based substances. These drugs might cause significant health hazards and also have the potential to cause addiction. Recently some parts of India have already observed an upsurge of synthetic cathinone use (mephedrone, commonly known as "meow meow"), and there is a clear threat for the future.
Aims of this symposium: The questions asked and discussed in this symposium, roughly in this order, are: What are NPS? How does it differ from usual psychoactive drugs? What are the prevalence, trend, context and geographical distribution of their usage? This would be followed by a discussion on synthetic cathinones which is the current menace for our country. Synthetic cannabinoids ("Spice"), widely used across Europe and America, are yet to be reported in a large scale from India. This could be a potential threat for the future.
Keywords: New Psychoactive Substances, NPS, ketamine, piperazines, synthetic cathinones, synthetic cannabinoids.
Baseline Results from the SMART Mental Health Project in Rural Andhra Pradesh
Pallab K Maulik*, Siddhardha Devarapalli, Sudha Kallakuri
* Associate, The George Institute for Global Health, Banjara Hills Hyderabad, [email protected]
Background: A large number of people in the community suffer from mental disorders but only 15-25% receive any sort of mental health care as per existing research in countries like India. This is especially a problem in rural communities where existing resources and trained mental health staff are even less than that in urban centres.
Aim: The SMART Mental health project aims to ascertain the feasibility, acceptability and preliminary effectiveness of a mobile-based mental health services delivery system in rural Andhra Pradesh
Method: The study is being conducted in the West Godavari district of rural Andhra Pradesh. It uses a pre-post design. The baseline assessment was done in 12 villages (Pop~40000) using tablet devices and the respondents were asked specific questions about mental health and its determinants. This would be followed by an intervention that would focus on screening and managing common mental disorders such as depression, suicidal risk and emotional problems by primary healthcare workers. At the end of the intervention a post-intervention survey would identify any changes in mental health services use and mental health status amongst those who were screened positive at baseline.
Result: The results of the baseline survey will be presented and the key findings will be highlighted.
Discussion: The public health and project specific implications of the study will be discussed.
Keywords: SMART Mental Health Project, mobile-based mental health services.
Skill Building in Dementia: Non Pharmacological Management Approaches for Behavioral & Psychological Symptoms
Nisha Mani Pandey, Priti Singh, S.C. Tiwari
Dept of Geriatric Mental Health, King George's Medical University, Lucknow.
The management of dementia patients with behavioral and psychological symptoms (BPSD) is a challenging issue. The prevalence of BPSD affects nearly all people with dementia. With passage of time these patients show progressive decline in their activities of daily living (ADL), behavior and cognition. Further, poor diagnosis, management strategies and no or minimal response to pharmacotherapy often worsen their conditions and put burden on caregivers. Multidisciplinary approach has been found to be one of the best options to improve condition of these patients as well as reduce burden of care givers.
Researches reveal that impact of non pharmacological management strategies and nursing care are promising when other approaches fail; if given in proper manner. These approaches consider the need of patients and their care givers and include variety of tasks including assessment and evaluation of the subject and their care givers, identifying risk factors and problem issues as well as feasible and effective interventions in view of family, socio-economic and cultural milieu of the patients.
Keywords: Skill building, Dementia, cross cultural aspects, BPSD
Various Facets of Community Care and the Interface of Private and Academic Psychiatric Practice
Nitin Gupta 1, BS Chavan1, G Prasad Rao, Parmod Kumar
1 Department of Psychiatry, Government Medial College & Hospital, Chandigarh, [email protected]
According to the Global Burden of Disease Study of 2010, Mental and substance use disorders are the leading (22.9%) cause of years lived with disability (YLDs) worldwide. The movement of community psychiatry care has been around for the last 4 decades. However, apart from the NMHP and DMHP, the development has been isolated to a few parts of the country and more disjointed than coming across as cohesive and planned. Impetus has been mainly from the academic institutions. The Department of Psychiatry, GMCH, Chandigarh is one such institution which has dedicated itself to community care over the last 2 decades. Additionally, in the recent years, there has been a change in the scenario of delivery of mental health care services across the country, with private sector gradually making an impact. This will be reflected in the second presentation wherein delivery of community outreach services using the private sector model will be highlighted. Services in the community are generally geared towards delivery of acute care of the mentally ill. However, for continuity of care, there are few established centres for medium to long term care for patients with chronic mental illnesses. This is true more so for rural than urban set-ups, with numerous hurdles and logistical issues which will be highlighted in the third presentation. As mentioned earlier, NMHP and DMHP have primarily have remained geared towards rural community care. Urban mental health has been a neglected area. Nevertheless there have been initiatives in the form of a community care model from the Department of Psychiatry, GMCH, Chandigarh to address the treatment gap for mental illness in Chandigarh.
Keywords: Community care, Community outreach services, NMPH, DMPH, Urban Mental Health
Interventional Psychiatry. History, Current Status and Future Directions.
Ekram Goyal*, Adnan Kadiani, Shivaji Marella, Daniel Saldanha
*Department of Psychiatry, DYPMC, Pune, [email protected]
Objective: The goal of this workshop is to understand the Sub Speciality of Interventional Psychiatry. The speakers will endeavour to give
- A historical perspective.
- Details of procedures currently in practice.
- The status in Indian clinical practice and training needs.
- Future directions - methods under investigation and theoretical possibilities.
Brief Description: Interventional psychiatry is an emerging subspecialty that utilises neuro-technologies to identify dysfunctional brain circuitry underlying psychiatric disorders and apply brain stimulation techniques to modulate that circuitry.
Interventions in Psychiatry have had a long - if chequered - history. The very effective and continuously used ECT; the ill-advised prefrontal leukotomy; the forgotten insulin sub-coma; are all methods that have had their day in the sun both professionally and in popular culture.
The new millennium has brought to the fore more modern and effective techniques to both understand the brain and modulate its circuitry. Neuro-imaging including functional imaging in combination with EEG MEG and ppTMS have given psychiatrists greater insight into the pathways of dysfunction in psychiatric disorders. We also now have in our armamentarium new methods to modulate the brain with TMS, tDCS, DBS and VNS.
Newer avenues open up every day with startling research into Brain Computer Interfaces, Implantable Chips and Virtual Reality.
With the large body of evidence to be covered and need for focused expertise arises the question of courses and curricula along with appropriate regulation.
Keywords: Interventional Psychiatry, prefrontal leucotomy, tDCS, Brain Computer Interfaces
Assessment and Treatment of Psychosis: Contemporary Perspective
Ali Khadivi*, Sasidhar Gunturu
* Bronx-Lebanon Hospital Center, Bronx, NY Associate Chairman for Clinical Care, Evaluation & Research Chief Psychologist Direct clinical and forensic psychological assessments services Co-chair of High Risk/Forensic committee
The diagnosis of psychosis continues to evolve and the current diagnostic classification system has made important changes in both diagnostic criteria and to the clinical significant of certain psychotic symptoms. The goal of this half-day workshop the present to most updated evidence based approaches to assessment and treatment of psychotic disorders.
Learning Objectives: Participants will be able to: Describe the core symptoms of psychosis and distinguish dimensional and categorical concepts in diagnosis.
- Identify most recent changes in diagnostic criteria of psychotic disorders
- Describe effective clinical interview techniques to assess core psychotic symptom
- Distinguish psychotic symptoms from cultural/religious beliefs or experiences.
- Identify updated risk factors for suicide and violence in psychotic individuals
- Describe updated evidence based psychopharmacological treatment of psychotic disorders
- Describe the most effective medication treatment for first episode psychosis
- Identify best treatment strategies for refractory psychosis
Keywords: Psychosis, contemporary perspective, psychotic disorders
Obstructive Sleep apnea in Psychiatry practice
*Department of Psychiatry & Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun,
OSA is a common disorder that we often come across in Psychiatry practice. However, many a times we miss the diagnosis and give alternate diagnosis to the patients e.g., insomnia, depression and somatic symptoms disorder. Symptoms of OSA overlap with that of these psychiatric disorders and thus, many patients do not improve despite best of our efforts. Clinical diagnosis is easy if we have high index of suspicion and so is the treatment. Untreated OSA lead to a variety of medical complications.
The symposia will discuss OSA in Psychiatry practice, diagnosis of OSA: Clinical suspicion and sleep study, management of OSA patient and fate of untreated OSA
Keywords: OSA, Obstructive Sleep Apnea, sleep study
Hands on Training of Polysomnography: Scoring of Data
*Department of Psychiatry & Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun,
Sleep Study is required in many patients. In this workshop, we will focus on following issues:
- Hooking up the patient for the sleep study
- Scoring of EEG data: Sleep Staging
- Scoring of respiratory data: sleep apnea
- PAP therapy for OSA: mask fitting and manual titration
Keywords: Sleep study, PAP therapy, OSA, polysomnography
Applied Brain Research in Psychiatry - A scientific Quest in the Frontiers of Neurosciences
Uday Chaudhuri*, AbhayDey
*Department of Psychiatry, VIMS, Kolkata, [email protected]
PART : I: Brain research from bench to bedside - will be on pearls of wisdom from Applied Brain Research in the field of neurosciences. The lecture will cover neurotransmission, signal transduction, neuroplasticity, learning and memory. It will throw light on the Human Genome and The Human Connectome Projects, The human brain project by European Commission and Brain initiative by NIMH ( USA). It will also cover Optogenetics, Clear brain project( Clarity), The brain GPS system. Pleuripotent stem cell research, Brain computer interphase as well as recent developments in Neuro modulation techniques. Hope this will ignite the mind and brain of the learned participants towards neuroscience orientation.
PART : II: Will cover the recent brain research in Schizophrenia--- in search of the HOLIGRAIL.
Keywords: neuroplasticity, Brain research, NIMH, optogenetics
Parkinson's Disease: The Interface between Neurology and Psychiatry
Gautam Saha*, O.P. Singh, Alakananda Dutt
*Psychiatrist, Clinic Brain, Barasat, WB, [email protected]
Objectives: To highlight the need for Psychiatrists to detect signs of Parkinsonism in patients with psychiatric disorders as depression and anxiety disorders can precede the onset of Parkinson's Disease (PD) by several years and are now recognized as non motor symptoms of PD.
To improve skill for diagnosis and treatment of psychiatric disorders in patients with established PD. To demonstrate the neurobiological basis of psychiatric disorders in PD
Brief Description: The first presentation will highlight the high prevalence of psychiatric syndromes in PD and how Depression and Anxiety disorders often precede the motor signs and symptoms by several years while psychosis is usually seen in the later stages of the disorder. The focus will be on methods of diagnosis of psychiatric disorders in PD as well as on the detection of the early motor signs of PD in patients presenting primarily to Psychiatrists with depressive and/ or anxiety symptoms.
The second presentation will focus on the treatment of psychiatric disorders in the setting of PD highlighting the challenges like interactions between psychotropics and antiparkinsonian medicines, the positive and negative effects of both groups of drugs on the clinical presentation and the relative lack of evidence regarding the effectiveness of psychotropics in this condition.
The final presentation will aim to demonstrate PD as a neuropsychiatric disorder by focusing on the pathogenesis of motor and non motor symptoms of PD. The close association between the neurobiological changes responsible for the motor signs and the neuropsychiatric symptoms will be illustrated.
Keywords: Parkinson, Psyhotropics, neuropsychiatric disorder
Neurobiology of Addictive Disorders- From Aetiology to Treatment
Bhavuk Garg*, Deepak Moyal, Vijender Singh, Pankaj Kumar
*Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, [email protected]
Background: Keeping in mind the theme of the conference- Translational Psychiatry, we will present the basic neurobiology behind the addictive disorders, ranging from chemical addictions to behavioral addictions. The recent advances in research in this aspect will be discussed. How this research has been translated to clinical practice in explaining the aetiology of these disorders and identifying targets for treatment will be discussed.
- The Reward Circuit
- Neurobiology of Addiction
- Recent advances
- Therapeutic targets
Keywords: addictive disorders, chemical addiction, behavioural addiction
Innovative Approaches in Community Psychiatry
M L Agrawal*, Anuj Mittal
*International Fellow, American Psychiatry Association; Senior Psychiatrist & Director, Agrawal Neuropsychiatry Centre, Kota, Raj, [email protected]
Community Psychiatry is widely accepted care and treatment outside the setting of mental hospital. While it originates from the historical background of deinstitutionalization in certain western countries, it generally has developed along with basic Psychiatry services in many developing countries.
In India Dr Vidyasagar was probably the first Psychiatrist to start community Psychiatry by involving family members of patients admitted in mental hospital in Amritsar in the fifties & sixties and getting good results. Thereafter a chain of events occurred and two very significant community based projects were done in India - One was Raipur Rani Experiment in Haryana and the other was Sakalwara in Karnataka. Thereafter National Mental Health Program was implemented and focus was on Primary Health Care centers & General Hospital Psychiatry. This was followed by focus on development of psychiatry clinics, involvement of families in psychosocial rehabilitation and involvement of NGOs.
As this was happening in other parts of India, Dr M L Agrawal with his team at Kota in Rajasthan and adjoining regions, was working in a unique way towards creating awareness and guidance for mental illnesses at the grass root level. He observed that in India we celebrate a lot of festivals throughout the year where a large number of people are collected at one place. To reach the common man he started putting up exhibitions/ jhankis /Tableau during these festival fairs and melas. Initially the awareness material used was translation of WFMH packets in Hindi and later indigenously developed by psychiatrists and psychologists of Dr Agrawal's team in local languages. He involved organizations like scouts & guides, NGOs like Rotary club and Lions Club to develop other audio visual aids for these programs. Hindi translated material were distributed to community leaders like Panch, Sarpanch, teachers, members of NGOs, scout and guides. Road shows were done, press conferences were organized and awareness material was published in local newspapers. Religious leaders of various segments such as Hindu, Muslims, Sikhs, Christians were also involved to propagate mental health awareness in the community.
Every year special event was organized during Dusshera Mela of Kota which is celebrated for almost 30 days during Dusshera and Diwali season. Millions of people from all corners of the country attend this event. During these 30 days Mental Health awareness is done through exhibitions, small plays, lectures, distribution of education material and hosting discussions with the visitors.
Dr Agrawal is doing these kind of community Psychiatry services for last 30 years. These efforts have been recognized and applauded by national and international Psychiatry community. He was awarded with the prestigious RC Hunter award of excellence several times by World Federation of Mental Health in recognition of its innovative approach and consistent services in the field of community psychiatry.
Keywords: community psychiatry, WFMH packets, Psychiatry services
From Teenager to screenager- The impact of electronic media on the brain
Devavrat G Harshe*, Sneha D Harshe, Rucha Sule
*Department of Psychiatry, Dr D Y Patil Medical College, Hospital & Research Centre, Kolhapur, [email protected]
The human brain thirsts for stimulation. Electronic media quenches that thirst by offering a plethora of data and images at the click of a mouse or a touch of the screen. There is a growing concern however, that increased use of electronic media has resulted in increased distractibility, changed critical thinking skills and impacted the way we approach complex problems.
Electronic media such as video games and online games also have an impact on behaviour. Games which require aggressive responses to dangerous situations strengthen the neural circuitry that processes similar decisions in real world. Online gaming, gadgets with bright screens have been shown to be equally addictive as cocaine and alcohol!
Thought provoking contribution suggests that the challenge isn't as hopeless as it seems, that the electronic media developments many consider to be culturally negative may actually be intellectually positive. Thus, properly used, every medium, without exception can provide opportunities for human learning and development.
Objectives: This symposium is aimed at discussing the impact of various electronic media including television, internet, videogames and smartphones on the brain.
The effects on the brain in terms of memory, cognitive processing skills, Attention, critical thinking as well as Decision making will be covered.
Further the topic of behavioural addictions pertaining to electronic media will be touched upon.
The symposium will help develop an insight into the brain of the new teenager who is also a "screenager".
Keywords: electronic media, Behavioural addictions, screenager
Cannabis in Modern Times- Challenges and Opportunities
Yatan Pal Singh Balhara 1 , Ashwani Kumar Mishra, Siddharth Sarkar SK Khandelwal
*Department of Psychiatry and National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, [email protected]
The symposium is aimed at presenting the challenges and opportunities associated with cannabis in modern times. This shall include the challenges such as availability of high potency cannabis and synthetic cannabinoids as drugs of abuse. Additionally, the potential opportunities such as use of cannabis as a therapeutic modality and decriminalization of its use shall be discussed.
The Symposium shall Include the Following Presentations
Introduction: The first presentation shall present an overview of the symposium. It shall put forth the relevance of cannabis in modern times and highlight the importance of the current symposium.
High potency cannabis and synthetic cannabinoids: The second presentation shall focus on the problems and issues associated with availability of high potency cannabis (e.g. risk of cannabis incudes psychosis etc.). It shall also focus on the growing availability and abuse of synthetic cannabinoids. Some of the aspects that shall be included in this presentation include the epidemiology, pharmacological characteristics and medical (including psychiatric) aspects of synthetic cannabinoids.
Extent of problem of cannabis abuse in India: The third presentation shall focus of the epidemiology of cannabis abuse in India. The main focus shall be on the findings of the National Survey and data from the treatment seekers at the de-addiction centers across the country.
Cannabis: opportunities: The fourth presentation shall focus on the opportunities offered by the ongoing debate of medical marijuana and decriminalization of cannabis use. The current state of evidence on these issues and critical appraisal of the same shall be discussed.
Keywords: cannabis abuse, marijuana, cannabinoids
Legal Insanity, Fitness To Trial - Practical Issues
Indu V. Nair*, Akshara Mishra
*CONSULTANT, MENTAL HEALTH CENTRE, TRIVANDRUM, KERALA, [email protected]
Background: The interface between law and psychiatry is complex and has potential for gross misunderstanding. Each discipline has its concern for the person, but they speak different languages. The judicial language is binary, the person is either competent or not, dangerous or not dangerous, criminally responsible or not responsible. On the other hand medical discipline is on a continuum that ranges from the healthy to the very ill, there being different stages in between. Psychiatric concepts are relative, multi factorial and far from absolute. A patient with schizophrenia with persecutory delusions and some cognitive impairment, still preserves most cognitive skills. So also associated factors like alcohol or drug abuse and personality traits play crucial roles in a person's behaviour. So the opinions regarding legal responsibility, fitness to stand trial, testamentary capacity etc. becomes difficult, the content is often "lost in translation".
Two main instances where psychiatrists are often called to court are dealt with here - the insanity defense and fitness to stand trial. The evolution of the insanity defense internationally as well as nationally, shows that nothing much has changed, things are far from clear. What is it that as an expert witness a psychiatrist is expected to do? The topic of fitness to stand trial is also a difficult issue in many instances. Is it not time that the archaic laws incorporate newer advances in medicine ?
The aim of the symposium is to raise some clarity in these often repeated issues for which psychiatrists are summoned to the court.
Keywords: Legal insanity, law and psychiatry, defense
Early Intervention Programmes For Prevention Of Mental Illnesses In Infants, Children And Adolescents: An Indian Perspective
Smitha Ramadas*, T V Asokan, U C Garg, Rakesh Chadda
*Department of Psychiatry, Govt Medical College (MCCH), M.G. Kavu, Trichur, Kerala, [email protected]
In current context, Prevention and early intervention is any activity that is aimed at identifying and / or treating risk factors for, or early symptoms of, emotional and behavioral disturbance that may lead to mental illness in childhood or adolescence.
It is known that a significant number of infants, children and adolescents experience some form of mental illness. These have a profound impact and enduring consequences when left unchecked. Those affected, bear a major burden in suffering, lost opportunities and reduced social and economic outcome in the adulthood, including reduced participation in workforce. The adverse outcomes include reduced self-esteem, educational and occupational efforts and an increased risk and incidence of substance abuse, family conflict and sexual and physical abuse. Many international regulatory bodies of psychiatrists and pediatricians have come up with position statements for prevention of mental illnesses in infants, children and adolescents but unfortunately, the Indian bodies and Policy makers have been found wanting.
The evidences in favor of early identification and intervention are well established. There is an immediate need for strategies to identify the individuals at risk and improving the mental health of the young, while developing measures that can be implemented in the current infrastructure of the various health missions. Some suggested areas could be:
- Increasing funding for child and adolescent mental health services,
- Training of manpower engaged in the screening of children at currently functioning centers, such as Anganwadi workers, ANMs, etc.
- Collaboration between health and education sectors to identify at risk children.
- To reduce the misconceptions and stigma associated with the childhood mental disorders.
- Focus on specific prevention and early intervention programmes to address certain key target groups: children with behavioral problems, developmental disorders, depressive disorders, children who self harm or who are at risk of suicide, children of parents with a mental illness
Keywords: Intervention programmes, mental illnesses, children and adolescents
Managing Catatonia: What Options Do We Have?
Rishikesh V Behere*, Sujit Sarkhel, Samir Kumar Praharaj, Manu Arora
*Professor, Department of Psychiatry, Kasturba Medical College, Manipal, [email protected]
Objective: Catatonia is far infrequently observed in western countries, but is still prevalent in developing world including India. Although common, the treatment options available are limited, including benzodiazepines and ECT. The objective of this symposium is to discuss the current understanding of catatonia and evidence-based treatment options available.
Brief description: Catatonia is a common presentation in developing countries. They can cause significant morbidity and impact on the quality of life. Despite being so common, there is very poor understanding of these conditions. The most common treatment includes benzodiazepines and ECT, although recommendations for the dose and duration are not always followed. Sometimes, in non-responsive cases other treatment is warranted.
Catatonia is a syndrome cutting across diagnosis, and has been accorded a special position in DSM-5. Although schizophrenia was considered to account for majority of cases previously, there is a shift in diagnosis in favour of mood disorders recently. Also, the neurobiological understanding has evolved in recent years from GABA to NMDA and beyond. Dr. Rishikesh V Behere will discuss the current concepts in diagnosis and neurobiological understanding of catatonia.
Benzodiazepines are the first line treatment in catatonia. In those not responding to benzodiazepines, ECT is the next option. Nevertheless, the most common reason for non-response is under dosing of benzodiazepines. Also, treatment recommendations vary according to clinical situations. Dr. Sujit Sarkhel will discuss the evidence-based recommendation on the use of benzodiazepines and ECT in catatonia.
There are situations where benzodiazepines and ECT are not helpful in the treatment of catatonia or are not tolerated well. Several other treatment options are available for managing catatonia in these situations. Dr. Samir Kumar Praharaj will discuss on the treatment options in catatonia, beyond benzodiazepines and ECT.
Although antipsychotics were the mainstay of treatment of catatonia previously, their use declined with the faster response observed with benzodiazepines and ECT. Still, there are situations where antipsychotics may be recommended in catatonia. Dr. Manu Arora will discuss on the role of antipsychotics in catatonia, with a special emphasis on amisulpride.
Keywords: Catatonia, amisulpride, benzodiazepines
Forensic Evaluations in Psychiatric Practice
Chandrashekar H*,Kuruvilla Thomas, Suresh Badamath
*Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, [email protected]
Mental health professionals in all types of practice settings can no longer afford to be ignorant of the law. Clinical and legal aspects are so intertwined that they seem inseparable. Clinicians are often called upon by the legal systems to provide testimony in a wide variety of cases, both civil and criminal. Present symposium will focus on examples of most common evaluations.
Different sections of this workshop include criminal responsibility, competence to stand trial, Workshop covers following on the civil side: competence to make a will, contract, fitness to work etc
Plan to cover historical back ground, recent case examples and sample report
Keywords: Forensic, clinical and legal, criminal
Translational Psychiatry-Braining the Mind in Private Practice
N M Patil*, Swaminath G, Abhay Matkar
*Dept of Psychiatry, JNMC,BELGAUM, [email protected]
The yawning gap between the neurological processes of the brain & psychological realm of mind continue to throw newer challenges in the understanding of human behaviour both during physiological states as well as during mental illness. Anthropologists, neuroscientists, philosophers & sadly to a lesser extent psychiatrists have made some strides to understand the suffering mind. The debate of Mindlessness & brainlessness in Psychiatry continues to be topic of wide discussion even today.
The translation of molecular biology to its destination of clinical practice is by itself challenging & throws many more questions. As clinicians we deal with tribulations of the mind to provide succour to people & offer relief from psychological distress.
Keywords: Translational Psychiatry, molecular biology, human behaviour
Undergraduates Training in Psychiatry
Roy Abraham Kallivayalil*, Harischandra Gambheera, T.V.Asokan, N.N.Raju
* Dept of Psychiatry Pushpagiri Institute of Medical Sciences, Thiruvalla, [email protected]
The importance of Psychiatry in the medical curriculum cannot be neglected for the following reasons.1.It stresses the concept of unity and mind 2.Psychiatric skills are necessary for all doctors and 3.Psychiatric problems are prevalent in all branches of Medicine. Undergraduate medical training involves a number of subjects for the trainee to go through and develop the skills necessary to manage the cases. In spite of increased significance, mental health has inadequate representation in UG curriculum. In India, the following initiatives are required on an urgent basis.1.Revising the curriculum and enhancing the quality of training 2.Strengthening teachers of Psychiatry3.Research in mental-health care. The UG training in Srilanka and South Asian countries are also discussed in this session.
Traditional teaching methods are directed more towards imparting knowledge than changing the attitudes of students. Newer teaching methods should be used to bring attitudinal changes and interest among medical students. Case based and problem based learning, small group teaching, simulated patients, using movies, multidisciplinary seminars, integrated teaching, attitude questionnaires, objective structured clinical examinations etc., could be introduced in the curriculum to achieve this objective.
Keywords: UG, undergraduates training, curriculum
Public Health Issues in Mental Health
Devashish Konar*, Varghese P. Punnoose, Roy Abraham Kallivayalil, Mohan Isaac
*Consultant Psychiatrist, Mental Health Care Centre, Kolkata and Burdwan, [email protected]
Till ten years back mental health had been restricted to the level of academic institutions, mental hospitals and private clinics in India. The major criticism of present day health care is that it does not serve the people who need it most. The millennial demand is to reach the advancement of brain science to the broader humanity. Knowledge which does not serve the real people in need is more like an ornament than a utility.
Private Sector and Public Mental Health: Private sector is growing at a greater pace than public sector, the reason being very little funds being infused into public sector. The needs of globalized aspiring Indian is not met up by the public sector. The problem of private sector is that it does not have any planning or guidance by the state and so develop unevenly and haphazardly. There are no incentives or relaxations for running services in unreached areas. We need to formulate them in consultation with the stake holders.
Government Sector and Public Mental Health: Government has been in the job through medical colleges and District Mental Health Program in planning and catering services which needs wider coverage.
Inclusion of psychiatry in undergraduate medical education as a subject will go a long way in improving psychiatric care of the country. For reaching the general doctors psychiatry needs to free itself of the jargons. Phenomenology, diagnosis, minimum required investigations, drug treatment and counselling should be the main knowledge transmitted to the family physicians. Criteria based diagnostic system or not so useful concepts like psychoanalysis should not figure in the training. A lucid description of illnesses would hold their interest. Psychiatry should permeate in thought process of doctors when they deal with health problems rather than be looked upon as a subject dealing with mental illnesses.
Social Psychiatry and Public Mental Health: India has one psychiatrist for every 2.8 lakh population. India's minimum target should be one psychiatrist for every one lakh population. The total number of postgraduate seats for psychiatry in India is only 400 and this should be increased to 1000. And then you need to solve the problem of uneven distribution of psychiatrists. Otherwise more the number, the more crowding of psychiatrists in the metros and big cities and still periphery will remain uncovered and unattended.
World Health Organization has proposed a specific target for mental health in the Sustainable Development Goals (SDGs), namely the provision of mental and physical health and social care services for people with mental disorders in parity with resources for addressing physical health. The WPA also proposed an increase in mental health investment.
International Perspective in Public Mental Health: Public health gives a broader perspective to health care. It has been in vogue for centuries now in planning of health for society. Public Mental Health is relatively new area of thinking which has drawn attention of World Health Organization, World Psychiatric Association, World Association of Social Psychiatry and other organizations. By being able to think and plan you just multiply the outcome of society's efforts. How other countries are doing it and what India can learn from it, will be discussed. Such a vast country as India with a huge population will need many more facilities for wider coverage. NGO's need to be involved.
Keywords: Public mental health, Social Psychiatry, Government sector
Poly-pharmacy and Drug Interaction in Psychiatry
Devashish Konar*, Debjani Bandopadhyay, Om Prakash Singh
*Consultant Psychiatrist, Mental Health Care Centre, Kolkata and Burdwan, [email protected]
Poly pharmacy was a pejorative term implying nonscientific and perhaps, even sloppy care. Poly pharmacy is very much part of psychiatry today. Though it is very much in vogue, there is extreme paucity of clinical studies that would inform evidence based poly pharmacy. If we all do poly pharmacy let us understand it thoroughly before we do it.
Relevance of Poly Pharmacy in Today's Psychiatric Practice: In difficult to treat psychiatric patients, poly pharmacy becomes a necessity. You do not have ideal drugs and yet you need to provide relief in shortest period of time. General aspects related to poly pharmacy and its relevance in poly pharmacy will be dealt with.
Poly Pharmacy Across Different Diseases in Psychiatry: Here poly pharmacy in context of major psychiatric illnesses will be taken up one by one and discussed. The aim of combining will always have to be better therapeutic results without increasing drug interactions and adverse effects.
Drug Interaction in Psychiatry: Drug interaction is a difficult subject and yet we need to understand it thoroughly to become a good prescriber in Psychiatry. Basis of drug interactions and its relevance in Psychiatry will be discussed.
Keywords: Poly-pharmacy, drug interactions
Daycare as Rehabilitation Tool in Psychiatry
Sivakumar T 1 , Krishna Prasad M, Dheeraj Kattula, Subhash Das, Kalayanasundaram S, Agarwal AK
1 NIMHANS, Bengaluru
The long-term outcome of patients with psychiatric disorders is likely to be better with rehabilitation inputs. In India, there are very few centres which offer psychiatric rehabilitation facilities including daycare. The services offered are mainly determined by resource constraints and clientele availing services. There is lack of awareness among mental health professionals about functioning and benefits of availing daycare services.
In this symposium, we shall discuss the practical experiences of offering daycare services in different settings: a Non-governmental organization working in psychiatric rehabilitation, resource intense apex tertiary care institution and missionary teaching hospital/ General hospital Psychiatry Unit.
The speakers will discuss about evolution of services, range of services offered, staffing pattern, financial implications, involvement of postgraduate students in offering services, and challenges in their setting. The utility of daycare as a therapeutic holding environment (not restricted to respite care of vocational training) will be discussed with real life examples. The symposium will conclude with perspective of need to train postgraduates about the concept and implications for future.
Keywords: Daycare, rehabilitation, vocational training
Cognitive Neurophysiology in Schizophrenia: Bridging Laboratory and Clinic
Sreeraj V S, Umesh Shreekantiah, Uvais NA, Vijay Mehtry
* Dept of Psychiatry, Translational Psychiatry lab, NIMHANS, Bangalore, [email protected]
Cognitive neuroscience is an integrative field of the scientific study of biological substrates underlying cognition with a specific focus on the neural substrate of mental processes. Cognitive neuroscience looks at the effects of brain abnormalities and resulting changes in the thought processes due to neural circuitry defects. Methods employed in cognitive neuroscience include experimental paradigms from psychophysics and cognitive psychology, functional neuroimaging, electrophysiology, cognitive genomics, and behavioral genetics. Neurophysiological tools like electrophysiological measures and eye movement tracking have paved way for newer understandings into the brain in health and disease.
Schizophrenia is a neurocognitive disorder. Neurocognition not only identifies the cognitive deficits but also helps in objectifying behavioural functions. Certain Cognitive functions could be indirectly measured or correlated with the neurophysiological measures. It is intended to approach the challenge of Schizophrenia through the cognitive neurophysiological markers. Cortical electroencephalography (EEG), evoked response potentials (ERP), Polysomnographic changes and eye movement dysfunction are few of the promising neurophysiological tools in Schizophrenia. The scope of these electrophysiological and eye tracking measures in classification, stratification, early and accurate diagnosis of Schizophrenia spectrum of disorders as well as personalizing therapy and pointing at the stage of the illness would be discussed through neurocognitive approach. The anticipated path of translating these research measures into the clinical decision making process needs an appraisal.
Keywords: Schizophrenia, neurophysiology, Polysomnographic
Prevention in Psychiatry: Indian Context
R.K. Solanki, Lalit Batra, Gunjan, Paramjeet Singh, Sanjay Jain
Burden of mental & behavioural disorders is enormous. About 450 million people suffer from mental & behavioural disorders worldwide. One person in four will develop one or more of these disorders during their lifetime. Neuropsychiatric conditions account for 13% of total Disability adjusted life years (DALYs) lost due all diseases and injuries in the world, and are estimated to increase by 15% by year 2020. Five of the ten leading cause of disability and premature death worldwide are psychiatric conditions. The mental disorders represent not only an immense psychological and economic burden to society but also increase the risk of physical disorders. The economic impact of the mental disorders is worldwide, long lasting and enormous. These disorders impose a range of cost on individuals, families and communities. The indirect cost arising from productivity lost account for larger proportion of overall cost.
According to WHO, to reduce the Health, social and economic burden of mental disorders it is essential that countries and regions pay greater attention to prevention and promotion in mental health at the level of policy formulation, legislation, decision making and resource allocation within the overall health care system. The proposed symposium is an attempt to discuss various evidence based strategies to promote mental health and prevention of mental disorders in India.
Mental health promotion interventions vary in a scope and include strategies to promote the mental well being of those who are not at risk, those who are at increased risk and those who are suffering or recovering from mental health problems. In prevention, intervention work by focusing on reducing risk factors and enhancing protective factors associated with mental ill health. The approach to mental disorder prevention lies in the concept of public health.
- Overview: burden of mental disorders & evidence base in prevention and promotion of mental Health: R.K. Solanki
- Risk and protective factors: strategies to reduce risk and improve quality of life: Lalit Batra
- Preventive strategies for conduct disorder, aggression and violence: Gunjan
- Strategies to prevent depression, suicideand Psychotic disorders: Paramjeet Singh
- Preventing substance related disorders and promoting positive mental health: Sanjay Jain
Keywords: Prevention, aggression, violence, Psychotic disorders
Cell Phone and Psychiatry
Venu Gopal Jhanwar*, Rajesh Nagpal, Priya Ranjan Avinash
* Psychiatrist, Deva Institute of Heathcare and Research, Varanasi,
Background: India is the second largest cell phone consumer market behind China. These fancy devices do keep everybody informed and keep everyone connected but do they really inform us about the health hazards they carry. Some of the serious health concerns like probable risk of cancers and hearing impairment are being probed all over, however one aspect of its use related to mental and behavioral disorders have not been focused much until recently. Mobile or cell phone addiction appears to be a recent common disorder that merits inclusion in new classificatory systems - ICD -XI. It fulfills the diagnostic components:
Excessive use - often associated with a loss of sense of time or a neglect of basic drives,
Withdrawal - including feelings of anger, tension and/or depression when the phone or network is inaccessible. Also symptoms of Nomophobia or Ringxiety.
Tolerance- including the need for new better cell instrument, more software or more hours of use
Negative repercussions - including lying (communifaking), arguments, poor achievement, social isolation, relationship problems, inattention and fatigue.
Mobile phone excessive use, also termed as "Screen Sucking" and its effect on various domains of cognition, primarily attention requires the attention of people working in the field of mental health.
Keywords: Cell phone, addiction, Ringxiety, Nomophobia, Screen Sucking
Rape: Sin, Crime or Disease?
Rachana P. Pole*, K.Rohit Sharma, Reshma Rajgopal
*VIMHANS hospital,Vijayawada,[email protected]
From the protests by feminine organizations to the highly criticized comments by various politicians, increasing number of rapes have taken Indian by sheer distress and disbelief. If one goes by the latest statistics of National Crime Records Bureau (NCRB), every day 93 women are being raped in the India. According to NCRB data, there is a gradual increase in the number of rapes reported in India - from 24,923 in 2012 to 33,707 in 2013.
Despite of several protests after Nirbhaya incident in New Delhi, the national capital continuous to be the most unsafe city. The number of rapes in Delhi has almost doubled from 585 in 2012 to 1,441 in 2013.
Delhi is followed by Mumbai, Jaipur and Pune among the top unsafe cities in the country. As Indian society is facing this rise in sexual crimes, there have been many speculations as to what are the etiological factors in rape and what measures can we take to prevent it. In the same context it is intriguing to examine the psychology of rape victim and also of the accused. Some states have also made a psychiatric examination of a victim mandatory. As we all are aware of the nature of psychopathologies that may develop after rape, there are still many areas unexplored.
Understanding various aspects of rape, its psychology, neurobiology and its social and cultural aspects is not only painfully interesting but is also a necessity of time. As psychiatrists we are frequently expected to intervene and provide primary supportive care to the victims and also opine about the presence or absence of any psychopathology in the accused. The documentation from medicolegal point of view in such cases is often a problem. In this symposium we intend to dig out the dirty dark side of human psyche which provocates them for committing the crime and provide insights on necessary interventions and instruments for the psychiatrists dealing with such cases.
Keywords: Rape, psychopathology, medicolegal,
"All you need to Know about Policy and Legal Issues Involved in the Treatment of Opioid Addiction in India"
Atul Ambekar*, Ashwin Mohan, Ravindra Rao
*NDDTC, AIIMS, New Delhi, [email protected]
Opioid addiction presents a sizable burden on the society. In many parts of India, a significant proportion of clientele in the clinical practice of psychiatrists comprises of opioid dependent people. Unfortunately, many psychiatrists are reluctant to use opioid agonists (such as Buprenorphine and Methadone) for treatment of opioid dependence due to stringent laws for their procurement, stock and dispensing. Despite a long experience with culturally-sanctioned use of opium, Indian laws and policies have tended to follow the policies adopted by western countries. The stringent regulations have ensured that opioid medications are not easily accessible to the needy patients, while addicts continue to access illicit opioids!
Though buprenorphine is categorised as a psychotropic, the use of this molecule for treatment is caught in a web of intricacies involved in the Narcotic Drugs and Psychotropic Substances (NDPS) Act (1985) as well as the Drugs and Cosmetics Act (1940). A number of professionals have been victims of subjective interpretations of the provisions under the law. The stipulation by the Drug Controller General, India (DCGI) of limiting the use of this medicine to 'hospitals with d-addiction facilities' has further added to the confusion.
Recently the Government of India has notified amendments in the NDPS Act to change the legal status of methadone as an "Essential Narcotic Drug." As per the new provisions, a registered medical practitioner can procure, stock and dispense methadone. The Standard Operating Procedures for registration and training mechanism for using methadone have recently been developed.
While it is perfectly legitimate to use these medications for treatment, the practitioners need to be aware of the intricacies in the existing laws and policies. As professionals, we also need to discuss and explore ways in which legal and policy reforms can be instituted, making life easier for the patients and doctors alike.
Keyword: opioid addiction, NDPS, Narcotic, psychotropic
PG Corner: Off the Beaten Track - Psychiatry Residency and Beyond
Rishikesh V Behere*, Naren P Rao, Girish Babu N
*Department of Psychiatry, Kasturba Medical College, Manipal,
Postgraduate residency in psychiatry is a challenging period. A student is expected to learn a number of specialized skills such as psychopathology, psychotherapy, psychopharmacology, clinical interview skills, which student may not have had exposure to during their undergraduate training. With the ever changing scenario in terms of advances in biological psychiatry, changes in classificatory system, newer pharmacological treatments, advancing evidence based medicine, a resident has to keep pace with newer advances while at the same time balancing knowledge of classical concepts. Preparation for exams requires a specialized focus and study skills. With the advent of technology, a sea of knowledge is open to a psychiatry resident. . Research is an important component of psychiatry residency training and learning the skill of conducting research and publishing their work could be an important asset in one's career. A psychiatry resident after finishing PG is faced with many choice with introduction of specialisation courses in the field of child & adolescent psychiatry, addiction medicine and the like. This symposium is largely directed towards the needs of psychiatry residents and will address the challenges and how to face them.
Keywords: residency, specialisation courses, training
Geriatric Mental Health Research in India - Current Status and Future Directions
P T Sivakumar, Mathew Varghese, Srikala Bharath
*Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, [email protected]
The mental health issues in elderly is emerging as a major public health problem due to the demographic changes across the world. This change is particularly evident in countries like India due to the large size of the population and rapid demographic ageing. India is likely to have one of the largest population of individuals with dementia. However the contribution of Indian research to understand the mental health problems in elderly has been inadequate.
Initiative such as 10/66 Dementia Research Group has contributed towards increase in the Indian research in this area over the past decade. There are several centers that have specifically involved in research on geriatric mental health issues. This symposium will review the current status of India research in this area and explore the possible future directions.
Keywords: Dementia, geriatric mental health
Womanizing Psychiatry: Doing it our way!
Aditi Acharya*, Rachana P. Pole
*Consultant Psychiatrist, Mumbai, [email protected]
The number of female doctors joining psychiatry in India has been steadily rising in last few decades. Psychiatry has gradually shifted from mental hospitals to the general hospital and community settings and is gaining more acceptability and respect in the society and this could have been a major factor for the change.
On the flipside of this attractive picture, medical field in essence is synonymous to long years of training and then long hours of work schedule. The scenario is even more threatening for females as they also have to juggle between career and family responsibilities. Whilst doing this commendable job, it has also been seen that females lag behind their male colleagues in attaining positions of authority and leadership in academics, professional organizations, and medical institutions. For example, women constitute 29% of associate professors, 15% of full professors, and 6% of department chairs in medical schools in USA. The women psychiatrists have been speculated to have poorer coping skills, more physical and emotional symptoms, and are more likely to report stress, anxiety and depression.
In India however the scenario changes even more significantly because of peculiar socio-cultural dimensions. Whilst the stigma about psychiatry is still significantly present in Indian society, for female psychiatrists many a times the entry into the field itself is often a major hurdle. And yet there have been more and more females opting for psychiatry.
So what are the reasons for choosing psychiatry over other branches? What are the pros and cons of psychiatry as vocation? How the cons affect your life in psychiatry and in general? What do the legends say about it?
In this symposium we intend to explore all these aspects and many more. This is intended to be a tribute to all the female psychiatrists in India and abroad and to provide some insights for the young budding female psychiatrists.
Keywords: Womanizing, family, female, emotional
Comprehensive Patient Centered Assessment and Management of Geriatric Neuropsychiatric Disorders
Vinodkumar Gangolli*, Mathew Varghese, Srikala Bharath, P T Sivakumar
*Department of Psychiatry and Neuro-behavioral Sciences, McMaster's University, Hamilton, Ontario, Canada, [email protected]
Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple co-morbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, and greater illness severity contribute to a higher risk of adverse outcomes.
Our presentation will review the most common conditions encountered in older patients, including delirium, dementia, depression, incontinence, frailty, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. The effective evaluation and treatment of geriatric patient requires a global approach, which
includes, but reaches beyond a consideration of the medical problems. Reuben(2003) defined geriatric assessment as a comprehensive patient evaluation conducted by an individual clinician or an interdisciplinary team, which considers the effect of key medical, social, psychological, and environmental factors on health and pays special attention to function.
Keywords: geriatric, delirium, dementia, assessment
Understanding Mental Mechanism - The Gain of Past Hundred Years
MSVK Raju, Shiv Gautam, DebasishBasu, KC Gurnani
*Department of Psychiatry, People's College of Medical Science & Research Centre, Bhanpur, Bhopal
In the first half of nineteenth century while speaking about the causes of mental illnesses in his article on 'Naming and Preliminary Classification of Mental Diseases', Friedrich Nasse (1778-1851) in Germany firmly stood for the traditional. He characterized each mental illness in terms of a disturbance in input or output of mental functions. According to him, "In amentia both input and output were suppressed, the manic was overwhelmed by his drives and the melancholic (i.e., the mentally ill in the narrow sense) was overcome by receiving too much input. In other words an affection of 'irritability' in mania and of 'sensibility' in melancholia."
The end of nineteenth century had seen the development of microscope and study of molecular structure of brain which had led scientist to change their doctrine of philosophy and in 1892, attributing to Maudsley, the President of American Psychiatric Association had stated "To him mind is only a generalization, a metaphysical abstraction of the nervous and cerebral phenomenon. Mental activity depends absolutely on the structure and nutrition of the brain. Maudsley concludes by congratulating himself on having succeeded in altogether eliminating internal experience, so as to arrive at the true facts of consciousness."
However, during the same era, while Sigmund Freud was elaborating on the concept of conscious and unconscious, the primary tenet of methodological behaviorism, as expressed in the writings of John B. Watson (in 1913) and others, was that psychology should have only concerned itself with observable events.
The beginning of twentieth century had also seen the dawn of the era of Kraepelin and Adolph Meyer, both of whom had the unique quality of accepting the theories of all the three schools, viz.: the psychoanalytic, the biological and the psychological, but for them the primary necessity of diagnosing and understanding any mental disorder rested upon defining fundamental symptoms.
Such was the waywardness of psychiatry during those days that expressing his anguish over the prevailing state of affairs in psychiatry, especially in America, PM Wise, while delivering his Presidential address before the American Medico Psychological Association, in 1901, had rightly stated, "It is often charged against our special branch of medicine that, in many respects, we have made no advance in the last hundred years. A representative journal recently stated that 'our knowledge of the essential nature of insanity, of the causes which foster and produce it, of the means by which it might be prevented and cured, is scarcely greater now than it was a hundred years ago.'" He had further stated, "The profession at large believes and boldly declares that we have no pathology of insanity and that we have no systematic treatment based on pathology, but that our treatment is purely empirical."
More than hundred years have passed since PM Wise had stated above words as well as all the three doctrines had seen their uprising. Every science concerned with the stated doctrines has worked to achieve its goal in defining the human mind, especially during the disease state and every scientist, concerned with the respective school of thought, seems to boast of their achievements and to provide the answer to the many maladies of human mind.
But do we have really progressed, is a big question. Can we correlate the observable phenomenon - the symptom or sign - with the non observable variable - the biological or unconscious? Or can the behavioral school produce or decrease the likelihood of any mental disturbance by their SR theory? And coming to the basic tenets of clinical facts, have we understood hallucinations in any better way than we were a hundred years ago?
There are many ifs and buts and many big question marks yet to be answered. And it is the time that we should awake from our somber and try to peep into our achievements and make a semblance of facts which can unite the achievement of different schools of thoughts.
Keywords: irritability, sensibility, melancholia.
Marriage vs Live In : Staying in or out of wedlock!
Indla Rama Subba Reddy*, Rachana P. Pole
*VIMHANS Hospital, Vijayawada
Live in relationship or cohabitation is not a rare practice in western world. Majority of the adults in western countries cohabitate before tying the knot. Slowly and gradually, live in relationships are becoming popular in India - especially across all major cities. Unlike a few years back, when social norms were strictly against such relationships even in the urban areas, a lot of young couples these days are living together without marriage.
Whilst Indian society is still struggling with the idea of love marriages as opposed to arranged marriages, live in relationships yet again challenge the monopoly of the matrimonial institution in India. This journey of cohabitation to marriage however is not as easy as it has been portrayed by media. Particularly in Indian society, which more often than not misinterprets its traditions and customs, there are several disadvantages of live in relationships.
Cohabitation or live in relationship often tends to be a human rightist and individualistic approach. Despite being highly prevalent in majority of the western countries, the reality with regard to the social fabric of India is drastically different. This can be understood from the fact that in India, marriage continues to be the institution that is preferred to any other form of union. But that is the reason why the society frowns upon the adults living together out of wedlock.
Whilst this issue has already started plaguing the societal health, it is interesting to examine its intricacies within the context of Indian social fabric and looking at its psychological perspectives. Do the couples who live together tend to be happier, healthier and experience any other benefits than married couples? Is there any scientific foundation to the image that is marketed in media in India and abroad? How does a psychiatrist come into picture? As we stand at the interface of social sciences and medical sciences, how should we equip ourselves for facing this change in one of the fundamental institutions of society?
In this symposium we intend to throw light on these issues and some more. In the same context we plan to review and compare marriage and live in relationship one by one for all the parameters in question.
Keywords: Marriage, Live In, Cohabitation, wedlock
"Behavior addiction -Clinical concepts and management issues
Shruti Srivastava*, MS Bhatia, Dinesh Kataria
*Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, [email protected]
Behavior addiction is a new entity that includes excessive use of internet,, sex, cell phone, compulsive buying, pathological gambling, online gaming, online shopping.DSM-5 has included pathological gambling along with Substance related and addiction disorder. Internet gaming is another condition kept for further study in DSM-5. With the technological advancements and fast changing pace of Indian society, the researchers in India need to apprise themselves of clinical criteria proposed, assessments, management of new clinical entities in the light of current practices. An overall neurobiology of different forms of behavior addiction with evidence from genetic studies, neurotransmitters (dopamine, serotonin), neuroimaging studies will be summarized.
Internet addiction: Few studies published from India have reported the prevalence figures from 0.3-38% for Internet Addiction(IA). The three conceptual models of IA proposed by Young (1998), Griffith(2005), Tao(2010). A preliminary findings from 213 college students from India will be presented as a prototype to understand early detection, assessments and management issues pertaining to this new entity in Indian context. A cultural context for already banned pathological gambling and other components of behavior addiction with special reference to Indian scenario will be discussed.
Exercise and sex addiction: DSMIV TR has defined excessive exercise that significantly interferes with important activities, occurs at inappropriate times or inappropriate settings or when the individual continues to exrcise despite injury or medical complications. Sex addiction is another entity that includes maladaptive pattern of behavior, which involves dependence on various forms of sexual expression in order to cope with the life stresses. Like other addictions, it includes urges, cravings, planning and acting out the behavior, and a sense of relief on engaging in the behavior, followed by withdrawal and repeated cravings. The proposed clinical criteria, assessment tools, management issues will be discussed.
Cell phone and food addiction: A case series of published cell phone addiction from India will be presented highlighting the detection, management of this entity from India. Food addiction, is a new concept characterized by the compulsive over-consumption of high fat or sugary foods despite knowing harmful consequences. Evidence based clinical detection and management issues pertaining to food addiction will be discussed. Food addiction has adverse physical consequences such as dyslipidemia, obesity, hypertension, diabetes, stroke, arthritis, kidney disease and death. It has a negative impact on the overall functioning of the individual leading to absenteeism, job loss. The negative Treatment includes identifying the precipitants, triggers, nutritional counseling, behavior modification, psychotherapy, medication.
Keywords: Behavior addiction, Internet addiction, Food addiction, Sex addiction, Cell phone addiction
Integration of Mental Health in Primary Care in India and Nepal: Experiences and Learning from PRIME Research Program Consortium:
Presentation 1: Development and piloting of a plan for integrating Mental Health in primary care in Sehore District, Madhya Pradesh, India
Rahul Shidhaye 1 , Sanjay Shrivastava, Vaibhav Murhar, Sandesh Samudre, Shalini Ahuja, Rohit Ramaswamy, Vikram Patel
1 Assistant Professor, Public Health Foundation of India; PhD Candidate, Maastricht University, the Netherlands, [email protected]
Background: The large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.
Aims: To operationalise the delivery of the WHO mhGAP interventions for priority mental disorders and design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.
Methods: Mixed methods were used including Theory of Change workshops, qualitative research to develop the MHCP, and piloting of specific packages of care in a single facility.
Results: The MHCP comprises three enabling packages: programme management, capacity building and community mobilization; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.
Conclusions: There are a number of challenges to integrating mental health into primary care which can be addressed through the injection of new resources and collaborative care models.
Presentation 2: Development and Pilot-testing of a Mental Healthcare Plan in Nepal
M.J.D. Jordans1, N.P. Luitel, P. Pokhrel, V. Patel
1Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands; Center for Global Mental Health; Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London,
Background: Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries.
Aims: To present the development, and content, of a Mental Health Care Plan (MHCP) in Nepal, and assess initial feasibility.
Methods: A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from beneficiaries (n=135) during the pilot-testing phase in two health facilities.
Results: The resulting MHCP consists of twelve packages, divided over community, health facility and organization platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates.
Conclusion: The MHCP follows a collaborative care model encompassing community and primary healthcare interventions.
Keywords: MHCP, pilot-testing, mhGAP
"Headache beyond head"
Anshuman Tiwari*, Abdul Qadir Jilani, Shantanu Bharti Gupta
*Assistant Professor, Department of Psychiatry, Era's Lucknow Medical College and Hospital, Lucknow
Headache is without question one of the most common presenting symptom in psychiatric OPD for evaluation. Not unexpectedly, the differential diagnosis of this highly prevalent symptom is vast with over 300 different headache types and etiologies. An expanding body of literature suggests that many psychiatric disorders such as depression, panic disorder, phobia and GAD are frequently encountered among patients with headache. Psychological factors such as psychological stressors, personality style, conditioning and psychodynamic issues along with common serious mental illnesses play significant role in the development and maintenance of headache. Evidence supports that many psychiatric disorders are significant risk factors for both the onset and chronicity of primary headaches. In addition, primary headache syndrome itself play important role in causation and exacerbation of psychiatric symptoms and disorders. One of the possible reasons for co-morbidity of headaches and psychiatric disorders is the underlying shared mechanism at structural and neurobiological level of central nervous system regulating pain and affective disorders e.g. Limbic system. Co morbid headache and psychiatric disorders mutually adversely affect course and prognosis of each other leading to complicated management and consequently poor quality of life. Therefore, understanding the biological connections and common etiopathogenesis of both can lead to improved diagnosis, treatment and outcome in patient population.
Keywords: Headache, GAD,
"Elderly Suicide: Scenario 2050"
Fiaz Ahmed Sattar*, Kiran Kumar K., Mridula . P., Munnawar Hussain S.
*Department Of Psychiatry, Vydehi Institute of Medical Sciences and Research Center, Bangalore, [email protected]
Suicide is a global health concern. According to the WHO, every year, almost one million people die from suicide and 20 times more people attempt suicide; a global mortality rate of 16 per 100,000, or one death every 40 seconds and one attempt every 3 seconds, on an average. Suicide worldwide was estimated to represent 1.8% of the total global burden of disease in 1998; in 2020, this figure is projected to be 2.4%. It is predicted that in the coming decades, there will be a tremendous increase in the number of elderly in India, with similar increase in elderly suicide. Persons above the age of 60 in India will increase from 76 million in 2001 to 137 million by 2021 (WHO GENEVA 1999). The ratio of completed suicide to attempted suicide in India is about 1:7 in the elderly, which is double the ratio of 1:15 in lower age groups. The average annual suicide rate reported in Indian studies range from 62 per 100,000 to about 95 per 100,000 for the general population, with age-specific suicide rates as high as 234/ 100,000 and 147/100,000 in elderly men and women, respectively. Global literature consistently reports higher rates of suicide in elderly male compared to females.
Various bio-psycho-social factors are involved in the phenomenology of elderly suicide act. Psychiatric and physical illnesses, functional impairment, personality traits of neuroticism and social isolation are salient vulnerability factors among older as opposed to younger adults. Risk factors may co-exist leading to greater risk, such as social isolation and depression or depression and drug abuse. There appears to be a complex interplay of different etiological factors in the causation of suicide in general and elderly suicide in particular. Given the fact that socioeconomic and cultural factors play a prominent role. It is worthwhile reviewing the phenomenon of elderly suicide in underdeveloped, developing and developed countries of the world.
Considering the magnitude of the problem and its public health importance, it is essential to concentrate on various preventive and intervention strategies to minimize this self-inflicted preventable tragedy. Numerous population based general strategies may be implemented by the government like restricting access to lethal means, crafting better economic policies, improving access to palliative and mental health care. There is also a growing need to reduce ageism and elder abuse. Over-the-counter dispensation of medications that may be fatal in overdose without a valid doctor's prescription must be stopped. Suicide prevention initiatives can be designed for implementation by the primary care physician treating the elderly. Education with regard to diagnosis and treatment of geriatric depression along with proper screening and treatment algorithms is essential. An active collaboration between primary care physicians and psychiatrists is important to achieve this end. There is a need for outreach programs in suicide prevention. This is essential for those with physical disability, immobility and lack of access to managed care. Strategies that identify circumscribed problems, seeking a well defined and motivated target population and tailor made interventions are essential for treatment and prevention of geriatric suicide when we move towards 2050.
In this background the Symposia shall be presented under the following headings by the respective speakers,
Keywords: suicide, elderly, geriatric suicide,
CL Psychiatry: Conceptual issues, Current status and Need for Change in future
Susanta Kumar Padhy 1, Subodh BN, Sandeep Grover
1Department of Psychiatry, PGIMER, Chandigarh, [email protected]
C-L Psychiatry / psychosomatic medicine, a special field of psychiatry encompasses diagnosis and treatment of psychiatric illness in complex medically ill patients. The basic concept of Consultation and Liaison Psychiatry (C-L psychiatry) involves consultation and liaison. Models focus on providing services, research, teaching and training in different permutations and combinations.
The 1 st speaker will speak about the conceptual issues, models and principles of C-L practice. The speaker will discuss the different models of CL Psychiatry practiced across the world depending on the clinical and training needs.
The second speaker will speak about the current practice of CL psychiatry in Indian context and problems with existing models. The speaker will present the models current service models followed in the current and lacunae of the same.
The third speaker will talk about the change required in the current practice, training and emphasis on CL Psychiatry in Indian setting. The speaker will discuss how emphasis on psychiatry during the undergraduate and post graduate training can help in popularizing psychiatry at different levels and increase the focus on CL Psychiatry.
Keywords: psychosomatic medicine, C-L Psychiatry, Liaison Psychiatry
A Forum for Psychiatry Teachers: To Improve Quality of Psychiatry Training in India
Mohan Isaac*, M V Ashok, M Kishore
*Professor of Psychiatry, The University of Western Australia and Visiting Professor, NIMHANS, Bangalore, E-mail: [email protected]
During the past decade, there has been a serious effort to increase the availability of trained mental health human resources, including psychiatrists in the country. The total number of entrants to 381 medical colleges in the country, annually, exceeds 50,000. The number of medical colleges and institutions providing post graduate training in psychiatry has steadily increased, offering, in total, more than 500 positions for degrees or diplomas in psychiatry. It is well known that there is marked variability in the overall quality and strength of psychiatry departments in medical colleges across the country. Consequently, the way psychiatry is taught to undergraduate medical students and the way post graduates in psychiatry are trained are highly variable. The severe shortage of adequately experienced and committed teachers of psychiatry in medical colleges, interested in teaching, significantly impacts the quality of not only undergraduate training in psychiatry but also training at postgraduate level and the quality and competence of our future psychiatrists. In a country with extremely limited mental health care resources, high quality teaching of psychiatry to undergraduate medical students and postgraduates in psychiatry is crucial to better provision of medical and mental health care. Medical teachers are generally self-trained. The ability of teachers of psychiatry to imbibe teaching / training skills and expertise is highly variable. Under these circumstances, efforts should be made to enhance opportunities for teachers of psychiatry to discuss and learn from each other issues related to psychiatry teaching, both at undergraduate and postgraduate levels.
The three presentations in this symposium will explore how psychiatry teaching and teachers' issues are dealt with internationally, critically explore if there is a need to organize a "Forum for teachers of psychiatry" in India, and how such a forum for skill enhancement of psychiatry teachers can be organized and sustained in the country.
Keywords: psychiatry teaching, teachers of psychiatry, Medical teachers
Punjab Opioid Dependence Survey (PODS): What have we learnt from it?
Alok Agarwal1, Atul Ambekar, Ravindra Rao, Ashwani Mishra
1National Drug Dependence Treatment Centre (NDDTC) &, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi,
Punjab has been receiving a lot of media attention for the apparently rising problem of drug addiction, particularly opioid dependence, especially among the youth. However, there are no reliable estimates of number of opioid dependent individuals for the state. Accordingly, the Ministry of Social Justice and Empowerment (MSJE), Government of India commissioned the Punjab Opioid Dependence Survey which was conducted by Society for Promotion of Youth and Masses (SPYM), an NGO, in collaboration with NDDTC, AIIMS and the Government of Punjab. The survey aimed at estimating the size of opioid dependent population in the state as well as assessing the profile of opioid dependent population, its access to drug treatment services and the current status of availability of evidence based services. Epidemiological research in the field of substance use disorders is particularly challenging. Due to the illicit nature of drug use and the social disapproval associated with it, drug use often becomes a hidden activity. Hence, a general population household survey - which is a resource intensive technique - is not suitable for such phenomena. These and many other factors were taken into account when planning this survey. We chose to estimate the size of opioid dependent population using "Respondent Driven Sampling (RDS)" coupled with a "multiplier technique". This unique methodology presented its own challenges during implementation owing to the complexities and intricacies involved. For the service provider survey, an online method of data collection was employed. The statistical analysis for RDS also requires special techniques and software, which however are not difficult to use. It took dedicated efforts and hard work by the team of researchers to complete the data collection within four months.
Overall, the story of conducting PODS is worth sharing with fellow professionals. This survey has resulted in lot of useful experiences which would come in handy while planning similar scientific exercises in other parts of the country. The proposed symposium would consist of four presentations highlighting different experiences gained from the Punjab survey.
Keywords: PODS, opioid, dependence, SPYM, RDS
Non-pharmacological interventions for children with ADHD
Om Sai Ramesh, Anand R, [email protected]
There is an increase in use of stimulants for the treatment of attention deficit/hyperactivity disorder (ADHD) in recent decades. However, the role of non-pharmacological interventions is an indispensable option available to reduce the symptoms in children and stress levels in their parents / caregivers. Developing and testing different non-pharmacological interventions has been a major public health concern. And it is imperative to reiterate from time to time the usefulness and acceptability of such strategies. This workshop updates existing non-pharmacological interventions for children with ADHD and highlights the potential value of parent training in particular. Finally, we introduce the Mindfulness Based Intervention and present initial evidence for its clinical value.
Mindfulness is the skill of being in the present. It is the non-judgemental and non-reactive moment to moment awareness of sensations, feelings, thoughts and impulses. It is developed from ancient Eastern traditions of yoga and vipassana meditation. The technique is novel and counterintuitive to modern approaches to ADHD in children. There is growing evidence base to support the effectiveness of mindfulness-based interventions in ADHD. Mindfulness training and practice in a child with ADHD enhances the activation of the prefrontal cortex, insula and cingulate cortex activating sustained attention and the direct experience network at the same time reducing the activity of the limbic circuits associated with stress, alarm reactivity and impulsivity.
Keywords: ADHD, Yoga, vipassana meditation, Intervention
From Distress to De-stress... Real World Stresses & Their Effective Management in Health Care Providers
Shirish M Sule*, Manjiri Datar, Rucha Sule
* Consultant Psychiatrist, Dr Kulkarni Nursing home, Nashik
Context: Stress is ubiquitous and follows us everywhere. There is no avoiding it whatsoever. It follows us around irrespective of our age, gender or profession. Working in the health care system has become stressful especially in the past few years due to a multitude of factors. The changing face of the health care system has taken its toll not only on the medical professionals but also on the hospital staff and employees who are a major part of the health care team. The result of all this has been reflecting poorly on patient care, which is the ultimate aim of health care providers. Therefore, the task at hand is to further our understanding of stress and improve its management in ourselves as health care providers before passing on the benefit to our patients. The goal is to have a preventive health care system with healthier and happier health care providers, trying to provide the best possible patient care.
Objectives: The stresses faced by the different people in the health care industry, including consultants, resident doctors, nursing staff, ward assistants and cleaning staff, has a detrimental effect on the productivity of the medical care team as a whole and in turn on patient care.
This symposium is aimed at discussing the various stresses faced by medical professionals and hospital staff in recent years. It also aims at discussing the newer tools for stress management, like the role of humor and positive coping strategies, socialization and proper ventilation in reducing stress. The role of diet and effective lifestyle management, which can be easily and effectively implemented in health care providers in reducing their daily stresses and thus increasing their work efficiency and output, reflecting in better patient care.
Keywords: distress, de-dtress, management
Metabolics in Psychiatry
Arshad Hussain*, Rayees Ahmad Wani, Mansoor Ahmad Dar, Tajamul Hussain, Sabreena Qadri
*Institute of Mental Health And Neuro Sciences, Srinagar Kashmir
Diabetes and Depression: Objective: To estimate the magnitude of depression in diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes.
Research Design and Methods: The research was descriptive with a convenient sampling pattern, 527 patients were enrolled for study from endocrinology department over a period of one year,(45subjects with Type 1 diabetes and 482 subjects with Type 2 diabetes) and 44 subjects with gestational diabetes) .Patients were interviewed individually using an interview questionnaire sheet formulated by researchers to assess sociodemographic profile and MINI neuropsychiatric screening was used to screen for depression which was then confirmed by consultant psychiatrist using DSM 4 diagnostic .MADRAS and CGI were used to assess severity of depression.
Results: 60 percent of those suffering from Type 1 diabetes, and 37.5 percent of subjects with Type 2 diabetes were diagnosed with depression. In our study the mean blood glucose (fasting) was 204.40 + 18.01mg/dl and 103.5 +17.37 mg / dl in Type1 depressed and non-depressed cases respectively and this difference was statistically highly significant 't' value 18.42 and p < 0.001 Type 2 depressed diabetics had mean blood glucose fasting of 182.95 + 47.5 mg/dl and Type2 non depressed patients had 19.02 + 53.51mg/dl and this difference also was been found to be statically highly significant (t =13.35 and p<0.001).
Conclusions: The presence of diabetes significantly increases the odds of comorbid depression. This study reveals that there is an association between diabetes and depression and the correlation between depression and diabetes is significant. Patients with diabetes should be screened for depression, provided referral to appropriate social services and psychosocial support, and involvement of mental health professions when needed.
Polycystic Ovarian Syndrome in Bipolar Affective Disorder - A Hospital Based Study
Background: Preliminary studies suggest a two-tiered relationship of mood pathology with endocrine disturbances. First, many of the medications commonly used in the treatment of bipolar affective disorder can have deleterious effects on blood levels of reproductive hormones and consequently on the hypothalamic pituitary- gonadal (HPG) axis and reproductive function. Second, there is evidence of reproductive dysfunction in women with bipolar affective disorder prior to treatment.
Objectives: To assess the comorbidity of Polycystic Ovarian Syndrome in patients of Bipolar Affective Disorder and to study risk factors associated with this comorbidity.
Methodology: 200 female patients with DSM-IV diagnosis of bipolar affective disorder, between ages of 15-45 years, were evaluated by an endocrinologist. Patients reporting menstrual disturbances or having any stigmata of PCOS were further subjected to hormonal analysis, which included LH, FSH, prolactin, and testosterone, in the early follicular phase of menstrual cycle. Diagnosis of Polycystic Ovarian Syndrome was made as per NIH criteria.
Results: Out of 200 patients, 46(23%) were diagnosed as having polycystic ovarian syndrome(PCOS). 45% (N=90) reported menstrual disturbances while as 27% (N=54) had polycystic ovaries on ultrasonography. 19.2% of the patients diagnosed as PCOS had history of valproate intake whileas 27.90% patients had no such history (p=0.15), and the mean duration of valproate intake was greater in the group with no PCOS (13.09±18.61 months) as compared to group with PCOS (7.89±14.12 months). No significant difference (p=0.07) was found in prevalence of PCOS among various drug groups (including the group on multiple mood stabilizers).
Conclusion: A higher prevalence of polycystic ovarian syndrome is seen in bipolar affective disorder irrespective of pharmacotherapy suggesting a common link between the disorders which might be in the form of disturbance in hypothalamic-pituitary-gonadal axis.
Effects of Switching from Olanzapine to Aripiprazole on the Metabolic Profiles of Patients with Schizophrenia and Metabolic Syndrome: An Open-label Study
Background: Patients with schizophrenia suffer high rates of metabolic derangements on some antipsychotic medications that predispose them to cardiovascular diseases. Keeping this fact in mind, we planned this open-label study to see the effect on various metabolic parameters after switching stable schizophrenia subjects, who had developed metabolic syndrome on olanzapine, to aripiprazole.
Methods: Sixty-two patients with schizophrenia who were stable on olanzapine and were fulfilling modified national cholesterol education program (ncep) adult treatment panel iii (atp-iii) criteria for the presence of metabolic syndrome were enrolled on the study. Patients were randomly assigned either to switch to aripiprazole or to stay on olanzapine, on a 1:1 basis. Cross-tapering over a period of 1 month was done while switching patients to aripiprazole. Laboratory assessment for metabolic parameters was done at baseline, 8 weeks, and 24 weeks after enrollment; efficacy assessment was done using the positive and negative syndrome scale (panss) at baseline and 24 weeks, the clinical global impressions severity subscale (cgi-s) at baseline, and the clinical global impressions improvement subscale (cgi-i) at 24 weeks.
Results: All parameters of metabolic syndrome (waist circumference, blood pressure, triglyceride level, fasting blood glucose, and high-density lipoprotein cholesterol) kept deteriorating in the stay group, compared with a continuous improvement in the switch group over time. At the end of the study, 26 patients (100%) from the stay group and 15 patients (42.8%) from switch group met the modified ncep atp-iii criteria for presence of metabolic syndrome (p0.001). There were no statistically significant differences between groups in psychopathology changes as measured by the panss total score and cgi-i scores.
Conclusion: Clinically stable patients with schizophrenia who are taking olanzapine and who have evidence of metabolic syndrome can be successfully switched to aripiprazole, with improvement in various parameters of metabolic syndrome and without any significant change in efficacy measures.
Prevalence of Metabolic Syndrome Among Psychiatric Inpatients: A Hospital Based Study
Background: Over the past few decades there has been a dramatic change in the human environment and way-of-life, globally as well as in Kashmir, resulting in escalating rates of metabolic syndrome. In particular, changing trends are seen in metabolic syndrome among patients with psychiatric disorders.
Aim: The objective of this study was to find out the prevalence of Metabolic Syndrome among psychiatric inpatients.
Methodology: This cross sectional study was conducted at Institute of Mental Health and Neurosciences Kashmir (Government Psychiatric Diseases Hospital Srinagar). A total of 213 inpatients with a primary psychiatric diagnosis as per Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) criteria were evaluated for the presence of metabolic syndrome. A modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criterion for the diagnosis of metabolic syndrome was used.
Results: The overall prevalence of metabolic syndrome was 34.74%.The prevalence was higher in females (43.3%) than males (28.5%) [p=0.029] and it increased with age (mean age 42.62 versus 36.08 years, p≤0.0001). The prevalence was higher (38.09%) in patients on psychotropic drugs than drug naïve patients (29.88%). Among the diagnostic subgroups, the prevalence was higher among unipolar depression (50.0%) and anxiety disorders (50.0%), while it was lesser in bipolar disorders (36.36%), psychotic disorders (25.0%) and other mental disorders (38.09%).
Conclusion: In conclusion, our study shows that metabolic syndrome is highly prevalent among psychiatric patients and needs to be addressed to prevent the risk for cardiovascular diseases.
Diabetes Mellitus and Impaired Glucose Tolerance in Patients with Schizophrenia, before and after Antipsychotic Treatment
Background: Treatment with antipsychotics increases the risk of developing diabetes in patients of schizophrenia but this diabetogenic potential of different antipsychotics seems to be different. Moreover, there may be an independent link between schizophrenia and diabetes. So we plan to study the prevalence of glucose dysregulation in patients of schizophrenia before and after treatment with various antipsychotics.
Materials and Methods: Fifty patients (32 males and 18 females) diagnosed with schizophrenia were evaluated for glucose dysregulation using oral glucose tolerance test, initially (drug naive) and after antipsychotic treatment. Age- and sex-matched healthy volunteer group of 50 subjects (35 males and 15 females) was taken for comparison. Results were interpreted using American Diabetic Association criteria.
Results: Though the glycemic status of the patient group was comparable with healthy controls initially but antipsychotic treatment was associated with glucose dysregulation. For first 6 weeks the antipsychotic (olanzapine, risperidone, haloperidol and aripiprazole)-induced glucose dysregulation was comparable, which was seen to be maximum with the olanzapine-treated group at the end of this study, 14 weeks.
Conclusion: We conclude that antipsychotic treatment of nondiabetic drug naive schizophrenia patients was associated with adverse effects on glucose regulation. For initial 6 weeks the antipsychotic-induced glucose dysregulation was comparable, which was seen to be maximum with olanzapine at the end of study, i.e. 14 weeks. Keeping this at the back of mind we can stabilize a patient initially with a more effective drug, olanzapine, and later on shift to one with less metabolic side effects.
Keywords: Metabolics, diabetes, glycemic, metabolic syndrome, bipolar, aripiprazole, olanzapine
Neuro-inflammation and Psychiatric Disorders: Current understanding and Role in Management
Anil Nischal*, Anuradha Nischal, Kabir Garg, Hiten Saresa, Manu Agarwal
*Department of Psychiatry, King Georges' Medical University, UP, Lucknow
The etiology of Psychiatric Disorders has been one of the most puzzling questions that researchers have faced for over a century. Many theories regarding their etio-pathogenesis and treatment have been proposed. During recent decades, evidence for the involvement of the immune system has accumulated. Schizophrenia has been associated with decreased mitogen-induced lymphocyte proliferation, increased numbers of total T and T-helper cells and the presence of antibrain antibodies in serum. Similarly, depression has been associated with increased seum interleukin and other pro-inflammatory markers, that have been found to reduce on anti-depressant treatment. Other diseases such as bipolar disorders and Alzheimers also have been associated with increased inflammatory markers and markers of oxidative stress. However, the exact pathophysiology of these diseases remains elusive. Pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)α may play an important role in the etiology and thus management of different disorders. Changes in cytokines and cytokine receptors, reactive oxygen species and even the function and numbers of leukocytes have been reported in plasma, serum, and cerebrospinal fluid (CSF) of patients with psychiatric disorders. Data suggests that genetically determined inter individual differences in inflammatory response systems may influence brain morphology in psychiatric disorders. Such observations have pointed to cytokines being a putative part of a common pathway of genetic and environmental components for vulnerability to these disorders. Treatment, with drugs has been shown to alter cytokine levels in the initial phases of treatment. Augmentation of antipsychotics and antidepressants with anti-inflammatory drugs has also shown to improve treatment response in such patients.
Keywords: pro-inflammatory, interleukin, cytokines
Current Understanding of Addictive Disorder: Theories and Their Implications for Therapeutics
Abhishek Ghosh*, AniruddhaBasu, Bharath Holla
*Drug De-addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh
Background: Addictive disorders are a scourge in modern society and they are a prominent public health problem. The word addiction means 'being enslaved' - initially the condition was explained by social factors and as an immoral behavior though Benjamin Rush was one of the pioneers to propound the 'medical model of alcoholism'. Among the different psychological models prominent are the psychodynamic, classical conditioning and the behavioral schools. Recently biological models have been overarching and they have also covered a long way starting from 'Jellinek to genetics' and have gone beyond the 'reward circuitry'. Recent theories explaining this enigma are the 'reward deficiency' hypothesis of Kenneth Blum, Robinson and Berridge 'incentive sensitisation', Koob's 'Anti-reward system and Allostatic theory' and Volknow's 'Impaired Response Inhibition and Salience Attribution'. Primarily basic science research has led to the definition of addictive disorders as a 'chronic brain disorder' drawing criticism from different quarters. DSM-5 has given a dimensional understanding and also made the recent addition of 'Gambling Disorder' which calls for more conceptual rigor in uniting the apparent disparate concepts of chemical and non-chemical dependency states.
Aims of this symposium: The aim is to understand the basis of addictive disorders - where we are and where we are heading for - both from the point of view of conceptual understanding as well as future therapeutic development.
Keywords: addictive disorder, chronic brain disorder, Allostatic theory, Gambling disorder
Caring Patients with Psychiatric Disorders in their Own Communities: Ground Level Challenges and Novel Initiatives
Swaminath G*, Ravindra Munoli, Naveen Kumar C
* Consultant Psychiatrist, Bangalore, [email protected]
Despite the ongoing efforts from the stake holders such as the governments and professionals, the treatment gap for psychiatric disorders is alarmingly high with 4 out of 5 patients remaining out of the treatment ambit in countries such as ours. In the past couple of years, in Karnataka state, some innovative efforts have gone on with the intention of reaching out to the communities. One such initiative has come from 'Chittasanjeevini Charitable Trust' (CSCT), Bangalore. This non-governmental organization has been formed from generous donations from the 'Infosys Foundation', Bangalore. The annual interest accrued that generates from this is being utilized for purchasing psychotropic medications which are being disbursed free of cost to patients with psychiatric disorders across the state by ways of treatment camps. These free treatment camps are conducted by different professional groups (each headed by a psychiatrist) across 10 different rural areas of the state. Hundreds of patients are getting benefit out of this initiative. This symposium focuses on various aspects of the activities of the 'Chittasanjeevini Charitable Trust'. Also, it focuses on the ground level challenges that are encountered in caring for patients with psychiatric disorders in their own communities.
Keywords: Trust, CSCT, communities, donations
From Stress to Success - Management of Stress in Today's Life
Rajashree Ray*, Saugata Bandyopadhyay, P. K. Singh
*Vedanta Centre for Healing Minds, Salt Lake, Kolkata,
Stress is increasingly common internationally and can take many subtle forms. The changes in the person are very complex and slow in evolution.
This workshop will involve participants in discussing and understanding stress, its consequences on our health and strategies to manage this response for healthier living.
The first session will discuss the Neurobiology of stress, the complex interplay between the autonomic nervous system and the higher brain areas in influencing stress response and after effects of the development of stress syndromes in reviewing what changes happen in thinking, motivation, emotion and behaviour. We will focus on how hormones and other physiological agents mediate the effects of stress on the body for protective and adaptive effects in the short term, but accelerates pathophysiology when they are overproduced or mismanaged.
There will be two activities on the general concept of stress, dispelling some myths and identifying associated physical, emotional, cognitive and behavioural symptoms and their impact on different systems.
Discussions on the transactional model of Occupational Stress will identify main causes of stress in work environment and its impact on Work-Life Balance.
In the second part of the workshop specific interventions of action-based strategies and Perception-based strategies will be discussed. Some of the areas explored in perception based strategies will be identifying processes of rational thinking, cognitive restructuring, overcoming pessimistic thinking, harnessing positive thinking, managing perfectionism, facing fears and overcoming fears of change. Action based strategies will focus on ways to prioritise and organise, managing boundaries, increasing autonomy, breaking bad habits and managing performance stress.
Toolkits and discussions on effective time management skills, assertiveness skills, effective interpersonal skills and relaxation skills will be included.
As part of Work related stress management, emphasis will be laid on communication and leadership skills, tips on team building and project management in multi-disciplinary team settings.
Keywords: assertiveness, interpersonal, transactional model, occupational stress
Harnessing the Potential of Audio Visual Media for Mental Health Care
Meena K.S*, Prasanthi Nattala, Aruna R.M. Kapanee, Santosh Loganathan, Mathew Varghese
Dept. of Mental Health Education, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, [email protected]
Aim: Audio visual media are educational tools with a multisensory appeal. The proposed Symposium aims to highlight the role of audio visual media in the context of mental health care.
Illustrations from NIMHANS: To achieve this objective, the Speakers will use illustrations from various audio visual media developed at NIMHANS in the last three years, and describe how these media have found useful applications in the enhancement of patient care, capacity building in mental health, dissemination of health information, and research. Specifically, these videos focus on the following: psycho education in the context of severe mental illness; management guidelines for primary caregivers; promoting adaptive communication and interaction patterns in families living with mental illness; addressing stigma and discrimination; psychosocial concerns with regard to epilepsy; relapse prevention in drug dependence. Selected video clips will also be played to reiterate the content/ perspectives shared with the group.
Keywords: Audio visual media, multisensory, psycho education
Scientific evidence: The Symposium will also present empirical evidence from prospective studies carried out at NIMHANS, demonstrating the effectiveness of the above-mentioned audio visual media in achieving positive outcomes and long-term recovery.
Conclusion: Finally, the Speakers of the proposed Symposium will share their experiences in the development of the audio visual media, including scripting, validation, and post-production issues. A critical analysis of the barriers and pitfalls encountered, as well as some possible strategies to overcome, lessons learnt, and recommendations for future work/ research, will also be presented.
The Art and Science of Being a Peer Reviewer
Yatan Pal Singh Balhara*
*Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), WHO Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences (AIIMS)
New Delhi, [email protected]
The workshop is aimed at the mental health professionals who are / plan to engage in peer review for academic journals. The workshop shall also be helpful to the residents at it will help them gain understanding in carrying out a critical evaluation of scientific literature. Additionally, the tools and resources that can help one become a good reviewer shall be discussed.
Keywords: journals, academic, scientific literature
"Where The Streets Have no Name": Converging the Different Subways in Child Psychiatry
Shyamanta Das*, Bornali Das, Sashibha Barman, Shamiul Akhtar Borbora, Angshuman Kalita, Rahul Mathur, Suranjita Mazumdar
*Department of Psychiatry, Gauhati Medical College Hospital, Guwahati, [email protected]
Background: The fact that majority of the mental illnesses have their first manifestation before one reaches adulthood is becoming increasingly clear. Thus, importance of further work in the area is felt considering this early expression. As in childhood and adolescence itself mental illness results in burden, the extent of the problem needs assessment. This can lead to appropriate plan for their prevention and treatment. But, data on which such approach is to be built is sparse.
"The heart of the matter": Epidemiology is no more about simply counting the numbers. At times, the numbers may be even misleading. It can represent several biases, such as referral services or socioeconomic status, etc. it is more so in child and adolescent psychiatry. The reason being that this population comes across various 'gatekeepers' in their way to proper management in the forms of parents, teachers, and paediatricians.
By talking about diagnoses (like 'acute polymorphic psychotic disorder without symptoms of schizophrenia without acute stress'), psychiatrists may draw criticism and ask for trouble because of allegation of 'medicalising' a child's problems. Parents, teachers, and paediatricians may like to call the same problems of the child by different names that can be broadly brought under the rubric of 'emotional and behavioural difficulties'.
The current classificatory systems, e.g. ICD and DSM do have categories for childhood and adolescence psychiatric disorders. But, they constitute few emotional disorders that are mostly anxiety-related. The same criterion that is applied for adults is used for those mood disorders occurring in children and adolescents. As a result, epidemiological studies find prevalence amounting to nil or minimal. Though, there are suffering and impairment in this population resulting from problems in the mood. Data collected empirically has to be good; based on which to determine how best to extrapolate adult criteria upon children, or should it be applied at all.
"Time they are a changing'": A new and simple way of classifying childhood and adolescent psychiatric disorders is to categorise them into three groups, namely developmental disorders, disruptive disorders, and emotional disorders. Developmental disorders include intellectual disability, the autistic spectrum, language and reading delays, and enuresis and encopresis. Disruptive disorders include conduct disorder and hyperactivity. Emotional disorders include anxiety, depression, phobias, somatisation, and obsessive-compulsive disorder. It is common to observe comorbidity within each grouping. Across groups, the comorbidity is less.
"Past, passing, and to come": We studied 26 children up to the age of 15 years, 16 of them were boys, attending psychiatry outpatient department of a newly opened academic medical centre in the initial six months from its inception from February to July 2011. We found nine children with emotional disorders, five with disruptive disorders, and ten with developmental disorders; comorbidity in our study was equal in both within each grouping and across groups.
We are also studying children and adolescents up to the age of 18 years getting admitted in a newly opened child and adolescent psychiatry unit in the initial three months from its inception from October to December 2015.
Apart from dividing the childhood and adolescence psychiatric disorders (diagnosed as per the tenth revision of the International Statistical Classification of Diseases and Related Health Problems) into the three groups of developmental, disruptive, and emotional disorders, as well as observing inter- and intra-group clustering, we also plan to apply tool such as MINI-KID to improve the validity and reliability of such a classificatory system.
Conclusions: There has been enormous advance in the classification of the childhood and adolescence psychiatric disorders and the empirical basis on which to support the current classificatory scheme is growing stronger; but, at the same time, more and more data are required toward this end for prevention and treatment of these conditions in this age group, as well as there are obstacles which are considerable to overcome for these approaches to become major steps forward.
Keywords: Developmental disorders. Disruptive disorders. Emotional disorders.
Alcohol Abuse Among Doctors: Is it Tip of Iceberg?
Arun V. Marwale*
* Department of Psychiatry, MGM's Medical College Aurangabad, N-6, CIDCO, M.S., India, [email protected]
Introduction: Alcohol use disorders (AUDs) is most serious amongst all substances and globally it ranks 5 th & 3 rd on the list of preventable causes of morbidity and mortality respectively.
Each year it decreases the life span of alcoholics by 10 to 15 years, and contributes to 22,000 deaths and two million nonfatal injuries.
Epidemiology: The national household survey on drug abuse(NHSDA 1996) reports life time prevalence of alcohol use in U.S. & European countries to be 78.8 whereas ECA data shows life time prevalence of 7.9.
In India, prevalence of ever users or using at least once in last 12 months is 20 -30 %. Where males were more than female users. As per ICD10 criteria, in National household survey about 4 % qualified for alcohol dependence
Studies in medical profession: Use and abuse of alcohol by doctors have reported with varied outcomes in several studies. While some concluded that physicians are prone to alcoholism others disputed this. Birch et al (1998) found that about two thirds of recently qualified doctors in United Kingdom.
Various rates of alcohol & drug abuse compared to general population ranging from 30 to 100 times are quotd. AMA council on mental health reported to have subjected 2.3 & 3.2 % physicians for disciplinary action for alcoholism.
Seniority: More senior doctors were using alcohol (40 %), than juniors (20%),who used variety of drugs & quite frequently. Amongst students prevalence was more in medical students.
Possible reasons for alcohol misuse: In senior doctors the possible reason was relaxation and relief of stress during daily practice. the long duration of training characterized by intense competition, excessive workload, fear of failure, and continued stressful situations even after graduation and during daily practice.11 are possible reasons for students and junior doctors.
Hurdles in reporting: Is it really an iceberg?
There are problems in these studies like reliability of information, changing trends of use, problems with resources, time lag etc. which may lead to underreporting
Complications and managements issues: Alcoholism in doctors leads to medical, psychiatric, social & legal complications similar to general population.
The management comprises of Pharmacotherapy (Detoxification, deaddiction), counseling, & attending self help groups so also the treatment of complications.
Outcome reports are variable, some claiming good outcome in doctors. These issues will be discussed in detail.
Correlates of Alcohol abuse by Doctors in Aurangabad City
*Department of Psychiatry, MGM's Medical College Aurangabad, N-6, CIDCO, M.S., India, [email protected]
Aims and Objectives: 1. To study the correlates of alcohol abuse by doctors in Aurangabad city, Maharashtra, India.
Study design: Cross sectional study
- A semi-structured proforma to record demographic, clinical variables and variables relating to specialty etc;
- Alcohol Dependence Data Questionnaire (SADD): This questionnaire assesses most recent drinking habits on a 10 item questionnaire with four point likert scale of 0-3. Total score is obtained by sum of all items and ranges from 0-45. A score of 1-9 indicates low dependence; score of 10-19 indicates medium dependence and score of 20-45 indicates greater to high dependence.
- Drinker Inventory of consequences (DrInC): It was developed by William R. Miller and assesses number of events that drinker sometimes experiences. It has list of 50 events and scored first as yes or no. If answer is yes then person has to specify frequency of event on a likert scale of 0 means never to 3 means daily or almost every day. This effectively assesses all the problems / complications arising out of alcohol use and also various effects of alcohol on body.
Data Collection: Above mentioned documents were created online and email was sent to all the members of IMA- Aurangabad Branch and other doctors who are practicing in Aurangabad but are not members of the IMA. Data is anonymous and identity of the doctor is not asked anywhere to ensure free participation. We are waiting for responses from doctors, reminders being planned to be sent on 25 th October 2015, and final data will be accepted till 15 th November 2015. To increase participation personal communications are being done by investigators through messages etc.
Results and conclusion: Data obtained will be analyzed for the demographic and social factors related to alcohol use, severity of alcohol drinking, any trends across specialties, correlations among various variables. Those who are willing for de-addiction will be offered appropriate treatment.
Keywords: Alcohol use disorders, AUD, NHSDA, Detoxification, deaddiction, SADD, DrInC, likert scale
"Drug Treatment Clinics": A Government of India Scheme to Promote Affordable, Accessible and Quality Addiction Treatment Services in India
Biswadip Chatterjee 1 , Alok Agarwal, Raj Kumar Lenin Singh, Shilpa Adarkar, Atul ambekar, Ravindra Rao, Sudhir K Khandelwal
1 National Drug Dependence Treatment Centre (NDDTC) &, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi,
- Current scenario of Drug de-addiction treatment in India(Alok Agrawal)
The current scenario of the drug de-addiction treatment in India is characterized largely by emphasis on the in-patient treatment provided at special 'de-addiction centres'.It is understood that there is a gross mismatch between the treatment demand and availability of resources. The problem is compounded by the low priority accorded to the mental health treatment and especially addiction treatment in the state government health budgets. Many hospitals, even if willing to provide treatment services are unable to do so owing to lack of financial and human resources.
- Need for a low-resource intensive standardized treatment: the concept and implementation of scheme of Drug Treatment Clinics (DTCs) in India (Biswadip Chatterjee)
To address the challenges in provision of addiction treatment services, the Ministry of Health and Family Welfare (MOH&FW), Government of India through its Drug De Addiction Programme (DDAP) has launched a scheme "Establishing Drug Treatment Clinics (DTCs)." This scheme wil be coordinated at the National level by NDDTC, AIIMS, New Delhi. At present the scheme is being implemented by five hospitals across the country and shall be scaled-up to 22 hospitals by the end of present five-year plan period.
- Experiences and challenges of drug de-addiction treatment in a DTC (Raj Kumar Lenin Singh)
The basic unit of this whole scheme is the Drug treatment Clinic. This DTC is managed by the especially recruited contractual staff (a doctor, a nurse, a counsellor), and functions under direct supervision of a nodal officer (consultant psychiatrist) of the government hospital. Free-of-cost medicines are available to the patients including those required for long-term maintenance treatment. The implementation in government hospital has been fraught with many challenges and yet has brought about many benefits too.
- Capacity building and mentorship: role of medical teaching institutions as Regional Resource and Training Centre (RRTC) (Shilpa Adarkar)
Certain medical institutes function as the Regional Resource and Training Centres (RRTC) under this scheme. They are entrusted with the task of contacting hospitals in their areas, establishing contacts, helping establish the new DTCs, providing training to the contractual staff and managing the flow of funds. This would bring about additional benefits to the teaching institutions and enhance their portfolio of academic and research activities.
- The way foreword: "spread wide, spread right"(Biswadip Chatterjee)
This scheme is being implemented as a model which could pave the path of scale-up and substantially enhance the number of DTCs in the future. Applying the lessons learned during implementation of this phase has the potential to change the profile of addiction-treatment sector in the country.
Keywords: DTC, RRTC, Drug treatment Clinic, DDAP, de-addiction treatment
The Marital &Extra-marital Gamble: Understanding Relationships.
Jayita Deodhar*, Vasant Mundra, Neena Sawant
*Department Of Phy (Psychiatry) Tata Memorial hospital, Mumbai, [email protected]
Background: The psychiatrist of today has clients who have several relationship issues and finds it difficult to tackle the same. Though there may be several reasons for the discord, lack of understanding on the spouse's part happens to be the most important one. Anguish, psychological pain, depression, anger, and humiliation are among the emotional experiences of the partners in distress and adding to the woes is the presence of infidelity. Infidelity may have no rival in disrupting a marital relationship. A sexual infidelity by a woman, either actual or suspected, is the leading cause of spousal battering and spousal homicide. Men on the other hand may get away with online and offline romances. Hence as a treating physician it is important to understand the male - female relationship and know the differences in thinking, emotions and behavior of both the sexes as it would have implications in therapy.
Aims & Objectives: This symposium intends to sensitize psychiatrists, psychologists and allied mental health professionals on the various differences of why men and women are different .The focus would be to apprise about the problem of infidelity and increasing the psychiatrist's understanding of handling these situations in practice.
Keywords: marital relationships, extramarital relations, infidelity, understanding men, understanding women
Early Detection & Prompt Remedial Action in Cases of Child Sexual Abuse
Kshirod K. Mishra*, Sushil Gawande, Dipika Singh
*Department of Psychiatry MGIMS. Sewagram, [email protected]
Child Sexual Abuse existed in different cultures since time immoral in same or other from. It is still a taboo in India. There is a conspiracy of silence about the subject as chunk of population fill this is primarily a problem of western subcontinent. In spite of India being a young's country where 19% of world's children population live, child protection in India has remained largely un addressed. Consequences of child sexual abuse can be serious and long lasting. It can hinder the normal social growth and cause varied psychosocial problems. Early detection and prompt intervention will be helpful in harm reduction.
By this workshop we intend to sensitize the mental health professionals in their role in early detection of childhood sexual abuse in different settings and how prompt intervention can be helpful towards the trauma reduction and limitation in future consequences.
Keywords: Child Sexual Abuse, protection, psychosocial problems
Electrophysiology as Diagnostic tool in Psychiatry
RohitVerma, Kishore Dudani, Shaily Mina, Shreegopal Goyal
*Department of Psychiatry, AIIMS Delhi
Though we are approaching the100 th anniversary of the demonstration of first recording of a human electroencephalogram (EEG) by Hans Berger, still electrophysiology currently plays a limited role in the diagnosis and management in psychiatry. This status is not supported by the existing literature. Psychiatric illnesses are largely subjective diagnoses. Developing diagnostic electrophysiological techniques that are non-invasive and relatively inexpensive can significantly impact diagnosis and management of these disorders.
Electrophysiology research arguably generates more research results than any other brain imaging technology, owing to the low cost of performing EEG studies and the low burden on research subjects. Mood and thought are not just chemistry - they are oscillations, and patterns of oscillation may help to diagnose psychiatric illness and predict response to treatment.
The underutilization of electrophysiological tests in psychiatry is propagated by the fact that the laboratories providing the service are not managed by psychiatrists. The current status of the clinical applications of psychiatric electrophysiology can be appreciated by capitalizing on the widely accepted indication to rule out medical causes of psychiatric symptoms (e.g., epileptic activity) and to begin developing Psychiatry-based Clinical Electrophysiology Laboratories (PCELs) as the equipment and skills necessary are basic to the entire discipline.
The power of electrophysiology to reflect pharmacological effects and treatment susceptibility is an also important research direction for electrophysiology.
Keywords: Electrophysiology, electroencephalogram, PCEL
Neurocircuitry in Psychiatric Disorders
Murali Rao*, Paolo Nucifora
*Psychiatry and Behavioral Neurosciences, Loyola University Chicago, [email protected]
The field of psychiatric research has been never been more exciting and promising than now. The genomics, the innovative modalities of neuroimaging, even more recent developments such as optogenetic approaches, providing knowledge about precise neuronal circuits, the 'Connectome' project in full swing - already yielding previously unknown information regarding network patterns, structural and functional connectivity unique to certain syndromes - could soon herald early detection, prevention and personalized care first time possible in our field.
Specifically, diffusion tensor imaging offers the opportunity to study the integrity of white matter circuitry in vivo. By examining the diffusion of water, the anatomy of white matter tracts can be depicted in health and disease. Several key tracts, particularly in the frontal lobes, have been implicated in a variety of psychiatric disorders.
Functional MRI uses the oxygenation level of blood as an indicator of neural activity. It has long been used to study responses to external stimuli, but new methodologies have been developed to study the activity of the brain in its "resting state". Abnormalities in resting state functional connectivity are emerging as potentially sensitive biomarkers of psychiatric illness.
Quantitative structural MRI can complement studies of functional as well as structural connectivity. Using advanced image analysis techniques, precise measurements of cortical surface area and thickness can be made. This can provide an indicator of early loss of neuronal tissue, long before it becomes visible to a trained radiologist. Ultimately, quantitative brain measurements may provide an anatomic substrate to explain changes in brain connectivity.
This emerging knowledge paired with emerging new neuromodulation technologies conceivably could refine those technologies and might allow selective activation of specific neuronal networks as added modalities to our current treatments. We could certainly anticipate a neuroscience-based diagnostic system in near future.
Keywords: optogenetic, Connectome, neuronal circuits
How to Read an EEG: A Workshop for Psychiatrists
*Dept of Psychiatry, Seth GSMC & KEM hospital, Mumbai,
Background: Many times our postgraduate training does not involve a basic understanding of how to read an EEG. Our training includes identifying some spike and sharp wave discharges and some seizure patterns which do not tell us about the utility of EEG. Indeed, learning to read EEGs is like learning to read a foreign language. To read a new language, one needs first to learn the alphabet. The alphabet of the EEG consists of the various frequencies and waveforms that comprise the tracing. Just as the letters of the alphabet are combined in different permutations and combinations to form words and then sentences, so the EEG tracings are made up of combinations of waveforms of different frequencies and morphology. EEG reading involves analyzing the waveforms and deducing their significance. With experience, one uses a speed reading technique in which a whole page is rapidly scanned for evidences of normal and abnormal phenomena. How successfully this is done depends to a large extent on developing pattern-recognition skills. Numerous EEGs need to be seen before one becomes familiar with the wide range of normal variations in different age groups and physiological states. The task becomes even more difficult when tracings of neonates and premature infants have to be interpreted. It may take two or three years of experience in reading before one has acquired reasonable expertise. But it is essential to sensitize psychiatrists and postgraduate students to the different aspects of EEG recording, hence the workshop.
Aim: To teach the psychiatrist how to read an EEG
- To understand the basic principles and techniques of EEG.
- To discuss normal EEG, EEG artifacts, wave forms and common EEG abnormalities seen in patients.
- Group activity involving reading EEGs.
Keywords: EEG, normal EEG waves, abnormal EEG wave forms EEG artifacts
Workshop ON mECT
Nikhil Chougule, Vidyddhar Watve, P M Chougule
Since it's development in 1938 by Cerletti Bini in Italy the Electro Convulsive Therapy has remained crucial part in Psychiatrist armamentarium in the treatment of major psychiatric illness. Continuous research has resulted in numerous refinement in treatment techniques. Recommendations in last decade regarding optional practice have included new ideas regarding patient selection, stimulus dose titration under general anesthesia. The International Society for ECT and Neurostimulation in accordance with it's mission to promate the safe and effective use of ECT commissioned on task force 1997
The NICE(National Institute of Clinical Exellence) guidelines and Royal College of Psychiatrist have revised their criterias in 2003, 2005, 2009
In view of the present status and it's exensive use in India, we would like to conduct Workshop on mECT. This will be interactive session on various aspects of the procedure.
Keywords: mECT, NICE, Electro Convulsive Therapy
Doctor-patient Relationship in a Changing World - The Psychiatrist's Perspective
K.S.Pavitra*, Adithya Pandurangi, Abhay Matkar
*Department of Psychiatry, SDM medical College, Dharwad, [email protected]
The patient-doctor relationship is an important concept in health care, especially so in psychiatry. The symposium addresses the concept of doctor-patient relationship keeping communication a art as a main ingredient with an attempt to frame a conceptual structure of the factors that define this relationship with special emphasis on mental health professionals. The symposium will unfold the different dimensions of doctor-patient relationship including psychiatric consultation, therapeutic measures, model of approach to treatment modalities, consent and liabilities, confidentiality and patient protection. It also discusses the concept in the view of patient's perception, family's perspective, biological advances in Psychiatry, current scenario and ethical issues in newer mental health care bill - 2014.
Keywords: patient-doctor, relationship, mental health care bill
Recent Developments in Obsessive Compulsive Spectrum Disorder
Sharmila Sarkar, Rajarshi Guha Thakurta, Tanushree Bhattacharaya
*Calcutta National Medical College, [email protected]
Outline: Compulsive disorder (OCD) is a clinical syndrome whose hallmarks are excessive, anxiety-evoking thoughts and compulsive behaviours that are generally recognized as unreasonable, but which cause significant distress and impairment. When these are the exclusive symptoms, they constitute uncomplicated OCD. OCD may also occur in the context of other neuropsychiatric disorders, most commonly other anxiety and mood disorders. The question remains as to whether these combinations of disorders should be regarded as independent, co-occurring disorders or as different manifestations of an incompletely understood constellation of OCD spectrum disorders with a common aetiology. Additional considerations are given here to two potential aetiology-based subgroups: (i) an environmentally based group in which OCD occurs following apparent causal events such as streptococcal infections, brain injury, or atypical neuroleptic treatment; and (ii) a genomically based group in which OCD is related to chromosomal anomalies or specific genes. Considering the status of current research, the concept of OCD and OCD-related spectrum conditions seems fluid in 2010, and in need of ongoing reappraisal
Keywords: Compulsive disorder, OCD, chromosomal anomalies
Child and Adolescent Mental Health: Indian Perspective
Rajesh Sagar*, Bichitra Nanda Patra, Rachna Bhargava, Ankit Gupta
*Department of Psychiatry, AIIMS, New Delhi, [email protected]
Outline: Children and adolescents in low and middle income countries constitute 35-50% of the population. In India, the total number of children in the age group 0-6 years is158.8 million, which is 13.12% of the total population. The percentage of population in 0-14 year age group consists 30.9% of total population of the country. Poor mental health in child and adolescent period is associated with school failure, delinquency, substance use disorder and mortality. The prevalence of child and adolescent psychiatric disorder has been found to be 10-20% worldwide. In India, there is a wide variation in reported prevalence rate of child and adolescent psychiatric disorders, from 0.48% to 29.4%. A recent meta-analysis of Indian studies found the prevalence rate to be 6.46% in community and 23.33% in the school. Adolescent people also have a high rate of deliberate self-harm. In India, the average suicide rate for young women has been found to be 148 per 100 000, and for young men 58 per 100 000.It is difficult for a country like India to handle this huge problem with low mental health resources and very slow progression in child and adolescent psychiatry. As per the WHO, a child and adolescent mental health policy in developing countries may be part of an overall health policy, a child and adolescent health policy or a mental health policy. However, as per the child mental health atlas of WHO, no low income country including India has a document related to policy on child and adolescent mental health. This warrants an urgent need to develop a separate child and adolescent mental health policy in our country.
Keywords: child mental health, adolescent psychiatry, self-harm
Preventive Psychiatry in Undergraduate Medical Curriculum: Should it be there?
RK Chadda 1, Mamta Sood1, Nitin Gupta2, Dinesh Kataria3
1 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, [email protected]
2 Department of Psychiatry, Government Medial College & Hospital, Chandigarh
3 Department of Psychiatry, Lady Hardinge Medical College & SK Hospital, New Delhi
According to the Global Burden of Disease Study of 2010, Mental and substance use disorders are the leading (22.9%) cause of years lived with disability (YLDs) worldwide. Medical Council of India recommends 20 hrs of theory lectures and 15 days of training in psychiatry. Training in psychiatry at undergraduate level is largely geared towards identification and treatment of various psychiatric disorders with no discussion about public health.Nowadays, globally in the training of medical undergraduates, importance of public health is increasingly emphasized. In the curriculum of UG psychiatry, by including epidemiological principles of primary, secondary and tertiary prevention, it will be possible to introduce concepts of positive mental health, early identification and treatment of psychiatric disorders, rehabilitation, and stigma. Also, UGs can be sensitized to the importance of community treatment and caregivers, facilities for psychiatric treatment and national mental health programme. At the All India Institute of Medical Sciences, New Delhi, public mental health is included in the lecture schedules and faculty is involved in regular training in community psychiatry along with community medicine in 7 th semester. The present symposiumwill discuss about the need for preventive psychiatry in undergraduate medical curriculum and how it can be included in the curriculum.
Global Burden of Mental Disorders: RK Chadda
Preventive Psychiatry in Primary Care: Nitin Gupta
Current status of psychiatry in UG curriculum: Dinesh Kataria
Preventive Psychiatry in UG Curriculum: MamtaSood
Keywords: Mental and substance use disorders, UG psychiatry, community psychiatry, YLD
Bedside Cognitive Assessment in Older Adults: Emphasis On use of Standardized Mini Mental Status Examination (Smmse)
Shrikant Srivastava * , Om Prakash, Hitesh Khurana, Abdul Q Jilani
Department of Geriatric Mental Health, KGMU, Lucknow,
Abstract : Published in 1975 by Folstein, Folstein and McHugh, Mini Mental Status Examination (MMSE) is a widely used clinical bedside instrument to screen and monitor cognitive disorder like delirium and dementia. The greatest advantage of MMSE over other instruments available is its being short, therefore, quick to administer. Folstein et al gave only few instructions for its administration which offers the interviewer flexibility in administration. Due to the same reasons, this tool has also certain disadvantages. Being short it can be easily remembered and rehearsed introducing bias. Due to differing techniques of administration, it is not considered a reliable tool by many authors. Its sensitivity is also low especially for screening moderate to severe dementia. The standardized MMSE(sMMSE) developed by Molloy (1999) has tried to overcome these limitations by comprehensive instructions for its administrations, scoring and interpretation. Consequently sMMSE is found to have better reliability and sensitivity to differentiate between cognitive disorder due to various cognitive disorders and depression.
The proposed symposium-cum-workshop will be presented under following heads:
- Tools for cognitive assessment: An overview: Dr Shrikant Srivastava
- Use of Mini Mental Status Examination (MMSE): its advantages and disadvantages: Dr Om Prakash
- Standardized MMSE (sMMSE): Why needed & how to administer: Dr Hitesh Khurana
- Demonstration of sMMSE: Training workshop: Dr AQ Jilani & others
Keywords: MMSE, sMMSE, Folstein, cognitive assessment
Newer Perspectives in the Management of Treatment Resistant Psychiatric Disorders in Children and Adolescents
Smitha CA 1 ,Neethi Valsan, Indu Nair 1 Govt. Medical College, [email protected]
Background: A large number of young patients with psychiatric disorders do not respond to the first lines of treatment. Treatment resistance could be "apparent" or "true" and the patients belonging to either of these groups might have different aetiologies and treatment needs. Factors that cause "apparent" treatment resistance need to be aggressively identified and actively corrected to enhance therapeutic effectiveness, whereas true treatment resistance need to be addressed in a systematic manner to get the best outcomes.
Objective: To discuss the factors contributing to treatment resistance in major childhood psychiatric disorders, and newer evidence based measures in their management.
Overview: We will address treatment resistance in schizophrenia, mood disorders, obsessive compulsive disorders and attention deficit hyperactivity disorder in child and adolescent population.
Keywords: Treatment resistance, Adolescent, schizophrenia, mood disorders, obsessive compulsive disorders, attention deficit hyperactivity disorder, Management.
Attitudes Towards Psychiatry in India
Bir Singh Chavan 1 , Suravi Patra, Naresh Nebhinani
1 Bir Singh Chavan, Department of Psychiatry Government Medical College and Hospital, Chandigarh, [email protected]
Background: By 2020 neuropsychiatric disorders in India would rank fourth in causing disease burden. These disorders increase the risk of communicable as well as non-communicable diseases and poor quality of life. As compared to general population, those suffering from severe mental disorders have a mortality gap of about 15-20 years which is often ascribed to the inequality of health care to physical illness in people with mental illness. Stigma still remains a barrier in providing healthcare in both non-mental health as well as mental health settings. In addition to stigma which hampers provision of services, attitudes of health professionals towards the patients with neuropsychiatric problems further compromise the quality of clinical care received by them.
Psychiatry is viewed negatively within the medical community. The prevailing negative attitude towards the discipline amongst undergraduates was mirrored through dwindling recruitment into the specialty since the last four decades which was evident in the editorials in British Medical Journal 'Not so popular psychiatry' and Lancet 'Who puts students off psychiatry.' Psychiatry as a career choice still remains unpopular amongst medical students.
Medical student's attitude towards psychiatry was extensively studied; their biggest turn off were the people who taught psychiatry. They viewed psychiatrists as 'confused', 'emotionally unstable', 'fuzzy thinkers', tended to over-conceptualize and often 'weird'. Psychiatric patients were perceived in general as 'not easy to like' Psychiatry as a vocation was felt unscientific, imprecise, ineffective and low in status as compared to other disciplines. Psychiatric education was considered a waste of medical education. Attitude to psychiatry was found amenable to change with medical training which resulted in positive improvements of attitude.
Teaching medical specialists attitudes towards psychiatry influences the attitude of students during their clinical training. The choice of specialty following graduation is determined by these attitudes. These attitudes further influences quality of clinical care imparted towards patients with psychiatric illness. The attitudes of medical specialists towards any specialty is determined by demographic factors such as age, education, gender, marital status and personality and beliefs about various features of a specialty like patient and prognosis.
Attitudes of specialists towards psychiatry are less well studied. The European studies have reported that two thirds of the specialists have moderate attitude towards psychiatry; obstetricians and surgeons harbor the strongest negative attitude towards psychiatry. The recent IMAGE study group has reported its finding from across 15 international trans-continental centers and has come out with grossly negative opinion towards Psychiatry and has recommended the need for improving perceptions of psychiatrists and efficacy of treatments.
The existing deficit in the number of psychiatrists would hinder meeting the projected mental health care needs of our nation. There is a necessity to systematically study the attitudes of undergraduate students towards psychiatry across the nation to have clear understanding of the current scenario which can help us in devising interventions as per need.
It is also needed to study the specialists' attitudes towards psychiatry across the nation because these attitudes nurture the attitudes of undergraduate students during their training.
Key words: attitude, psychiatry, medical students, specialists.
Mental Health Policy: Past Present And Future
Naveen C Kumar*, Sharad Philip, Suresh Bada Math
* Department of Psychiatry, NIMHANS, Bangalore, E-mail: [email protected]
Abstract : National Mental Health Program started way back in 1982 in India. Despite this, there was no comprehensive mental health policy for our country. NMHP was the sole guiding principle for mental health care across the country. As of today, District Mental Health Program (DMHP) is operational in about 125 districts of the country. However, its implementation is far from adequate with problems at every level. In this background, the Ministry of Health and Family Welfare, Govt of India formed a 'Mental Health Policy group' which came up ' New Pathways, New Hope', the country' first ever mental health policy in 2014. This symposium focuses on the following issues
- Mental Health priorities: glimpses from the past.
- National Mental Health Policy: A Critique
- Linking Mental Health Policy, Program and Legislation
Keywords: DMPH, Mental Health, National Mental Health Policy
mPsychiatry- Using Smartphones and Mobile Apps to Improve Efficiency, Effectiveness and Extent of Psychiatric Clinical Practice
T R John*, Somnath K M,
*Dept of Psychiatry, MOSC Medical College, Kolencherry, Ernakulam Dt, Kerala
Psychiatric knowledge is exploding at a furious pace. Knowledge is something that has been valued across time and cultures and evolved along with us. Learning has now become a full time activity. A modern mental healthcare practitioner needs to keep an eye on business aspects of his practice too. He has to increase the patient flow and revenue to remain in practice. However he cannot compromise the quality or duration of his patient interaction. Struggling to keep up these three roles of doctor, learner and manager has become almost impossible for a psychiatrist.
What is the solution then? Through Android Apps- Android apps has become a part of our daily lives and it can be utilized to help the modern practitioner.
Through this workshop, we hope to sensitize the modern day practitioner to the concept of mPsychiatry- Use of smart phones and Apps by Mental Healthcare Practitioners and patients to improve patient care, ensure patient safety and increase productivity. The participants will be trained in using a variety of Apps which will empower them to tackle different aspects of practice like medical knowledge, patient care, health administration, record keeping, financial management and medication management.
Keywords: mPsychiatry, Smartphones, medical knowledge
Psychodermatology: Where Beauty and Brain Need to Co-exist
Samir Kumar Praharaj*, Ravindra Munoli, Mahima Acharya
Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, [email protected]
Psychodermatology poses an interesting challenge in consultation liaison psychiatry with issues related to appearance and stigma add on to the skin condition and manifest in various psychological conditions. Treatment involves role of Psychiatrists, Dermatologists, Clinical Psychologists and Social interventions. Comprehensive management yields good result. The symposium focusses on the Psychodermatology conditions and our experience in the Psychodermatology clinic.
Part 1: How to approach a case of Psychodermatology
Part 2: Primary Psychiatric Disorders in dermatological patients
Part3: Secondary psychiatric disorders in dermatology patients (psychological manifestations of dermatological disorders
Keywords: Psychodermatology, Dermatologists, Social interventions
Improving Communication with the Caregivers of Persons with Mental Illness
Coordinators: Mamta Sood, Rakesh K Chadda, Koushik Sinha Deb, Rohit Verma
Facilitators: Ankit Gupta, Sathya Prakash, Rishab Gupta ([email protected])
Objective: To improve communication skills of the young psychiatrists and postgraduate trainees in their interactions with the caregivers in routine clinical practice.
In low and middle income (LAMI) countries like India, most of the patients with psychiatric disorders live with their families who play significant part in their care. During routine clinical practice, the caregivers provide vital information for formulating diagnosis and management. They remain important conduit for carrying out instructions for management. Caregivers experience substantial distress and burden in their caregiving role. Communication with caregivers as discussion about illness and caregiving role has been found to be associated with improved treatment adherence, better response and reduced relapse rate.
Family caregivers are one of the crucial resources available to psychiatrists practising in LAMI countries. Right from the beginning of training, young trainee psychiatrist is taught how to communicate with the patients for eliciting history, doing mental status examination, assessing various risks, etc. However, there is hardly any focus in training on how to communicate with caregivers, which is usually limited to taking history. Although postgraduate trainees during training in psychiatry routinely communicate with caregivers, it is unstructured, unidirectional with flow of information to caregivers without any emphasis on feedback and problem solving. Communication with caregivers of patients with psychiatric disorders remains an important skill for young psychiatrists and postgraduate trainees.
In the present workshop we aim to improve upon the communication skills of the young psychiatrists and postgraduate trainees while dealing with the caregivers in routine clinical practice. The participants will be given group work on the principles of problem-based learning. The groups will work on the problems at the end of a case vignette and will present solution as suggested by the group followed by discussion.
Keywords: LAMI, mental illness, caregivers, communication
Mirrors Neuron System in Patients with Schizophrenia: What we Know and what we Can Expect in Near Future?
*Sayantanava Mitra 1 ; Anjana Rao Kavoor ; Zeeshan Anwar
1 Department of Psychiatry, Sarojini Naidu Medical College, Agra, [email protected]
Mirror neurons (MNS) were serendipitously discovered in F5 sector of the macaque monkey ventral premotor cortex and were found to discharge in response to "observed" movements that had a specific goal. Together with similar neurons in the inferior parietal lobule, this parieto-frontal "action-organizing" has since been identified in humans and implicated in a multitude of functions; from facilitating automatic understanding of motor acts performed by others to enabling imitative learning, language development, ''theory of mind'' abilities and the construct of empathy.
The MNS has been credited with the success of human species, by enabling its members to form and sustain mutually interacting social systems through "understanding" actions and intentions of others. This basic human ability has been shown to be deficient in patients with schizophrenia, leading to delusions of reference, misidentification and persecution by misinterpretation of others' behaviours and underlying motives.
The inability of schizophrenia patients to "feel" what others were feeling is a well replicated finding, and recent researches have demonstrated abnormal functioning of MNS in this group; thus establishing a biological basis for these socio-psychological constructs. This impaired MNS functioning has further been hypothesised to be mediating psychopathology, probably through misattributions of agency or a disturbance in the sense of "self".
Recent improvements in neuroimaging and neuro-modulation techniques, along with innovative task designs, have all contributed to an explosion in studies exploring various aspects of MNS function in schizophrenia and related disorders. These advances, their clinic-pathological and probable prognostic implications shall be discussed through this symposium.
Keywords: Mirror Neuron System; Schizophrenia; Theory of Mind
The Insular Cortices: New Chalice of Neuropsychiatric Research
Seshadri Sekhar Chatterjee*, SayantanavaMitra
*Department of Psychiatry, Sarojini Naidu Medical College, Agra
E mail: [email protected]
Insular cortex (IC) has remained a relatively unexplored part of human brain, and is currently being implicated in great detail in various neuropsychiatric conditions. Thus this hidden gem is now one of the major areas of research in modern day psychiatry.
Being densely packed with mirror and spindle neurons, and having extremely opulentconnections with primary and secondary somatosensory areas, anterior cingulate cortex, amygdaloid body, prefrontal cortex, superior temporal gyrus, temporal pole, orbitofrontal cortex, frontal and parietal opercula, primary and association auditory cortices, visual association cortex, olfactory bulb, hippocampus, entorhinal cortex, and motor cortex; investigations suggest that sensory information including gustatory, olfactory, visual, auditory, and tactile inputs converge on the insular cortex, and that these multimodal sensory information may be integrated there.
Accordingly, it has been proposed to play a seminal role in processing emotions like disgust and fear as well as in mediating clinically relevant processes like visceral and motor functions. Thus this system is theoretically relevant in a number of pathological conditions and recent neuroimaging data as including voxel based morphometry, PET and fMRI support this proposition of its' involvement in various neuropsychiatric diseases such as mood disorders, panic disorders, PTSD, obsessive-compulsive disorders, eating disorders, and schizophrenia. In addition to these, newer conceptualizations also posit important role for this structure in basic neuroscience of self, interoception, embodied cognition, salience and consciousness.
We, in our symposium, will discuss the historical and scientific evolution of research on IC, its' neuroanatomy, neurophysiology and heuristic implication in neuropsychiatric disorders. We would highlight current research evidences and try to identify prospective thrust areas for future.
Keywords: Insular cortices, neuropsychiatric.
Pollution & Psychiatry
Dr. Kalpana Srivastava*, Dr Jyoti Prakash, Dr Kaushik Chatterjee
* Scientist F Armed Forces Medical College, Pune,
BRIEF DESCRIPTION : Dirt and contaminations are not only the subject concern for obsessive compulsive disorder; it can also contribute to many a neurological or psychiatric conditions affecting mood and behaviour. Over the years; industrialization, urbanization and increasing population has taken its toll. These have led to compromise in the healthy environment and increase in the unwanted pollutants. Would the advances in psychiatry be ready to tackle this growing concern or lag behind? The first step in this direction begins with understanding and appreciating the magnitude of this threat. We would hereby discuss the various pollutants and its role in various neuropsychiatric disorders.
Keywords: Pollution, pollutants, obsessive compulsive disorder, neuropsychiatric disorders
Dissociative Disorders in the Indian Context
Ganpat K. Vankar*, Nilima D. Shah, Radha Mehta
*Department of Psychiatry, B.J. Medical College, Ahmedabad
Outline: We intend to present the concept of dissociative disorders in general, including dissociation as a defense mechanism, occasional dissociative phenomena occurring in the context of other disorders and the various dissociative disorders per se, with a special emphasis on possession syndrome. The use of dissociative experiences scale and the dissociative disorders interview schedule to screen patients for dissociative phenomena shall be discussed in the context of a study carried out in indoor psychiatric patients. The different manifestations of dissociative phenomena in various cultures shall be discussed and in the Indian context, the underlying psychic mechanisms playing role in possession syndromes shall be discussed with various case examples and verbatim reports of patients.
Keywords: Dissociative disorders, defense mechanism, possession syndromes.
Sex Disorders-Past Present and Future
Ram Ghulam 1 , Ujwal Sardesai, Kapil Dev Arya
Department of Psychiatry, M.G.M .Medical college, Indore,
E-mail: [email protected]
A lot of untrained doctors and quacks work in the field of sex disorders. This is primarily because psychiatrists who specialize in the field do not take interest in practicing in sexual medicine. This is probably because of a big load of other mental health issues. Prevalence of sexual disorders is high and they are omnipresent in the population namely male-female, rural- urban, young and old; yet shame and ignorance keep the patients behind the curtains. History of studies in area of sex is ancient and very rich in India. It is most talked about but not explored academically. The symposium is aimed at reviewing present status of sexual disorders in lieu of our past experience and knowledge in the field to formulate strategies for future. It is also aim at igniting interest of the psychiatrist towards sex disorders. Three speakers will speak on following topics and will share experience from sex clinic being run M. Y. Hospital associated with M.G.M. Medical College Indore also.
Key words: - sex disorders, history, myths and misconceptions, current scientific approaches, future prospective.
Stress : Neuronal Aspects,Effect on Development of Brain And Prevention
Ujwal sardesai, Pali rastogi, Abhay paliwal
1. EFFECT OF STRESS ON EARLY BRAIN DEVELOPMENT, Dr.Ujwal sardesai
Childhood abuse and extreme stress has got severe effect on child`s development. Limbic circuit in particular is vulnerable to neglect and stress in first year of life leading to maladaptive synaptic formation leading to psycho anatomical developmental challenges. Stress is not a diagnostic entity and is all pervasive but excess stress is of great clinical importance. Clinical picture of stress is elaborated. Various models to predict and measure stress will be discussed along with discussion on their clinical use. Measurement and prediction about stress by Life events analysis and use of "Anticipation "as defense mechanism to lower stress (not only anxiety)is advocated. Measurement of current levels of stress by measuring autonomic indices and muscle tension will also be described.
2. GLIAL CELLS AND STRESS: IMPORTANCE, Dr.Pali Rastogi
Management of Stress has preventives value and scope In Psychiatry. It has been grossly misunderstood by Psychiatrist and often confused with anxiety, depression, etc. Hans Syle's work and model is discussed with emphasis to General Adaptation Syndrome and its description. Pathophysiology of stress, neurological concomitants and autonomic concomitant, Glial cells and polyamines play important role in brain function and dysfunction. They affect neuron and it`s functionality and therefore modify and play key role in development of many diseases and syndromes. Glial effect on depression, schizophrenia and suicidal ideation is being reviewed.
3. IMPORTANCE OF BREATHING PRACTICES IN MANAGEMENT OF STRESS RELATED DISORDERS, Dr.Abhay Paliwal
Neuropsychological studies shows normalization of emotional dys-regulation and autonomic dysfunction via breathing techniques. Various breath practices have shown to reduce symptoms of stress, anxiety, insomnia, PTSD, depression and other psychiatric diseases. Alleviating stress by life style modification, Biofeedback, Yoga and other contemporary relaxation, breathing techniques etc has definitive role to implement positive mental health. This has preventive role in various Psychiatric morbidities.
Conclusion: Managing Stress is of utmost importance to psychiatry and needs to be given more weightage in training and teaching and clinical work in Psychiatry. It will be a pillar for yet unformed branch of Psychiatry Namely "Preventive Psychiatry".
Keywords: Preventive Psychiatry, Glial cells and stress, Brain development, Stress
Nutritional Intervention in Management of Mental Illness
*Fellow of Australian College of Nutritional and Environmental Medicine (FACNEM)
Introduction: In this symposium, an attempt is made to look outside the box into additional factors which could contribute in the presentation of Psychopathology and why some of our patients don't respond to conventional treatment strategies.
Background: People with mental illness are often malnourished and recommendations for nutritional intervention are overridden by pharmacological methods. Even in the cases where the person may grow well, testing reveals some typical nutritional deficiencies in many important minerals, vitamins, essential fats, many amino acids and other nutrients. Majority of patients with mental illness have limited insight into their lifestyle choices and most of them don't have a General Practitioner.
Dietary history of the patient is often ignored. For eg, gut flora is something we do not think much about. And yet the number of functions the gut flora fulfils is so vital for us that if some day our digestive tracts were sterilised we probably would not survive.
Gut And Psychology Syndrome (GAP Syndrome or GAPS) establishes the connection between the state of the patient's gut and the functioning of the brain. This connection has been known by medics for a very long time. The father of modern psychiatry French psychiatrist Phillipe Pinel (1745-1828), after working with mental patients for many years, concluded in 1807: "The primary seat of insanity generally is in the region of the stomach and intestines." Long before him Hippocrates (460-370 BC), the father of modern medicine has said: "All diseases begin in the gut!" The more we learn with our modern scientific tools, the more we realize just how right they were.
Keywords: Nutritional Intervention, Mental illness, GAP Syndrome.
Are we Really Reaching the Unreached?-Print Media and Mental Health
Pavitra KS*, Sridhara KR, Shubrata KS
*SDM Medical College, Dharwad, [email protected]
The portrayal of mental health related articles in the newspaper and journals has been an incredibly powerful tool in educating and influencing public on mental health. The doctors as well as non-doctors by writing about health issues in the media are raising awareness about the mental illness. But the question is how extensive and accurate is the information provided in the media? This study was conducted to answer these questions. It reports the findings of an analysis of mental health-related articles in major daily newspapers of Karnataka. The study also attempted to find the number of psychiatric articles among the total health articles published and differences in presentation of mental health related articles by psychiatrists when compared to other doctors /non-doctors. The majority of the articles in mental health were concentrated on life style changes, child mental health related and depression. The articles were written in most instances by non-doctors and lacked in updated information and clinical expertise. Information on major mental illnesses were significantly not seen. The implications to early recognition, early contact and stigma reduction through print media will be discussed in the presentation.
Keywords: Print media, newspapers, journals, mental health
Combat Psychiatry : Perspectives from Land, Sea and Air
Vinay Chauhan, A K Gupta, Chaitanya Kodange,
Military psychiatry aspires to maintain psychological integrity of the soldier during war and peace. The field of military psychiatry gained recognition during World War I. Subsequent wars and conflicts have only not only emphasized its importance but have helped in formulating strategies towards its prevention and early management. Armed Forces across the world give special importance to this area and Indian Armed Forces are also keeping pace. With changing combat scenarios, peace keeping operations and terrorism modern soldier is obliged to confront and endure wide ranging demands from various directions. With battle fronts becoming diffuse and coming closer to home unarmed civilians are sucked into war like situations. Military psychiatrists as well as their civilian counter parts need to be aware of the essentials of the mental health consequences of military operations of various kinds and related situations. Combat stress experienced by troops in a war zone is the biggest attrition factor of trained manpower. There is need to identify it at the earliest and take preventive measures against its harmful effects. Armed Forces have three different arms i.e. Army, Navy and Air Force. Though the issues pertaining to the three arms may be different but principles of management remain the same. However, there is a need to update and to integrate the available information. The symposium will be an assimilation of information from three different arms of the Indian Armed Forces and will assist in formulating an integrated approach.
Keywords: Military psychiatry, war and peace, Armed Forces
Legislations in Relation to Children In India- What A Psychiatrist Should Know?
Hemika Agrawal, Deepak Moyal, Bhavuk Garg, Deepak Kumar
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, Email- [email protected]
Background: Children are one of the most vulnerable parts of the population. Their rights are of special importance and so is their protection. The legislative system also recognises this and there are specific provisions for this group. There are some important policies, acts and rules which are of special significance to the psychiatrists in their practice.
- Need for special legislations for children
- National policies with relation to children
- Provisions in Indian Penal Code
- The Juvenile Justice (Care and Protection of Children) Act, 2000 and amendments
- The Protection of Children from Sexual Offences Act (POCSO), 2012 and Rules
- The Commissions for the Protection of Child Rights Act, 2005
- The Prohibition of Child Marriage Act, 2006
- Child Labour (Prohibition and Regulation) Act, 1986
- The Immoral Traffic (Prevention) Act 1956 .
- The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995.
- Adoption related issues- Central Adoption Resource Agency (CARA)
- Right of Children to Free and Compulsory Education Act 2009
- Recent updates
- Way ahead
Keywords: Care and protection of Childern, Child labour, CARA.
Perinatal Mental Health Medication -Evidence Base
The management of mental health problems during pregnancy and the postnatal period differs from at other times because of potential impact of any difficulties and treatments not only on the woman but also have an effect on the baby. There are risks associated with taking psychotropic medication in pregnancy and during breastfeeding and risks of stopping medication taken for an existing mental health problem.
Depression and anxiety also affect 1520% of women in the first year after childbirth. Incidence of Postpartum psychosis lies between 1 and 2 in 1000 women who have given birth. Women with bipolar I disorder are at particular risk, of relapse after child birth (1)
Due to ethical issues good quality research is difficult to do in pregnant women hence limited evidence is available about efficacy and safety of medication in perinatal period.
This presentation is to look at recent evidence and recommendation about medication in perinatal period. Nice guideline, Maudsley Guideline, British psychopharmacology recommendations and looking at recent research about this topic and also looking at risk benefit analysis for giving or not giving the medication in perinatal period.
1 Nice guideline Antenatal and postnatal mental health: clinical management and service guidance. NICE guidelines [CG192] Published date: December 2014
Keywords: Perinatal Mental Health, Nice guideline, Maudsley Guideline
Rethinking Cannabis and Psychoses: Search for A Complex Mechanism
Umesh Shreekantiah*, Nizamuddin Parwez, Asha Krishnan, Shobit Garg
*K.S. Mani Centre for Cognitive Neurosciences, Central Institute of Psychiatry, Ranchi, Jharkhand
The association between cannabinoids and psychosis has been known for centuries. There is a broader understanding that cannabinoids may aggravate or worsen psychotic symptoms. However, it is still speculated whether cannabis use may precipitate psychosis in those at risk. Crow has rightly pointed that the population of individuals with or predisposed to a diagnosis of schizophrenia are inclined to seek out some addictive substances like cannabis. These individuals are disposed by their illness to consume more or stronger forms. Moreover, it is now clear that Δ9-Tetrahydrocannabinol (THC) can cause acute psychotic symptoms, such as paranoia, in a dose-dependent manner even in healthy individuals. Till date, none of the drug models for schizophrenia account for the complete picture of schizophrenia; rather, various drug models mimic different aspects of a psychotic illness. Hence, these findings have provoked interest in the understanding of the effects of cannabis and the role of endocannabinoids in schizophrenia. Certainly, an argument can be made that endocannabinoids may impact on the neurotransmitter system either directly or indirectly and play a pivotal role in development of psychoses. However, it is not clear that this effect accounts for their propensity to induce the characteristic symptoms of schizophrenia. Determining the different molecular effects of THC whose pharmacological effects might mimic the various aspects of schizophrenia has much to teach us concerning the pathogenesis of the illness. Finally, now schizophrenia is more appropriately viewed as at the extreme end of a continuum of psychosis where genetic and environmental risk factors (one being substance misuse) combine to push the individual over a threshold into expressing the characteristic clinical syndrome. It is time, therefore, to re-appraise the cannabis induced psychoses, and how they can help us to understand schizophrenia.
Keywords: Cannabis, cannabinoids and psychosis, endocannabinoids
Workshop : Stigma Reduction of Mental Illnesses and Mental Health Promotion through Public Education and Mass Media Interventions
Avdesh Sharma, Sujata Sharma, Manasi Sharma
E-mail: [email protected]
Mental illnesses are a problem worldwide but each culture differs in its perception of the problem. Similarly, the available infrastructure and facilities for treatment and rehabilitation may vary widely within a country, especially in India with its diverse cultures, socio economic status and systems of medicine apart from socio cultural background and service delivery systems apart from the cost.
The public education and media response to the challenge of awareness about mental health and illnesses must encompass local informal means of mass communication (word of mouth; opinion of leaders and doctors; folklore; street plays etc.) to tools of information technology at small level (local newspapers, magazines and radio; cable operators etc.) to National and International level (National Newspapers; National channels of Radio and Television; Satellite channels; Internet etc.). Each of these medias serves a purpose as well as target populations and is a piece in the larger picture of successfully integrating awareness, treatment and rehabilitation in a stigma free society.
Mental health now is in news all the time and psychiatrists are being called upon to interact with the media. Handling Mass-Media is an art and we all need to utilize the tools available to us to bring about public education and health awareness in the population to go beyond treatment and foster preventive health and demystify myths. The need is for us to be proactive and look for ways and opportunities to create awareness. It requires communication skills as well as understanding various medias to be able to harness them.
The Workshop would focus on hands on experience/practical aspects of handling the mass media to benefit largest section of the population in a sustained manner for mental health awareness, early intervention and comprehensive management apart from stigma reduction.
Relevance of Psychosocial Therapies in the Management of Serious Mental Disorders.
Murali Thyloth*, V.K. Radhakrishnan, C. Rama Subramaniam
*Department of Psychiatry, M.S. Ramaiah Medical College and hospitals, Bengaluru, [email protected]
The bio-psycho-social model has influenced the understanding and management of serious mental disorders in a number of ways. It is a fact that these disorders can lead to variable forms of disabilities in the affected individuals which are largely invisible. Firstly the understanding of this bio- psycho-social model and later translating this into regular clinical practice is a challenge faced by psychiatrists all over the world and especially in India. Secondly the preponderance of medical management alone in routine practice limits the scope of psychosocial interventions. Third factor is the limited exposure of psychiatrists about psychosocial rehabilitation in their training period which limits them to be in the comfort zone of prescriptions alone. This symposium will address these issues to provide a model of care based on the bio-psycho-social approach. Essentially there is evidence to say that disabilities are of biological origin and are modified by the environment. Current cost effective practices in different parts of India will be dealt, with examples of successful programs. For any successful program there is a need for adequate policy supports from respective governments to make it a public health program and the way this has been addressed with State Governments will also be presented.
Keywords: Psychosocial therapies, Serious mental disorders, psychosocial interventions
Psychiatrist as Physician and Physician as Psychiatrist.............Towards Holistic Psychiatry.
UDAY CHAUDHURI*, ABHAY DEY, ANIRBAN MAJUMDAR
*DEPARTMENT OF PSYCHIATRY, VIMS KOLKATA,
World health organisation (who) defines health as not merely absence of disease or infirmity but harmonious state of three wellbeings---physical mental, and social . psychiatry is an important branch of medicine which deals with behavioral, psychological and cognitive symptoms and signs leading to impairment of functioning. Many medical conditions mimic psychiatric disorders and many psychiatric disorders can arise out of medical causes or remain as co-morbidity . in this symposium, physician ( endocrinologist) will highlight internist as psychiatrist and psychiatrists will present medical conditions presenting as psychiatric disorders . finally synthesis and convergence of evidence will take us towards......a very satisfying goal " holistic psychiatry ".
Keywords: Holistic Psychiatry, World health Organisation, Harmonious
"Next Big Thing in Child And Adolescent Psychiatry"
Shoba Srinath*, Johann Philip
* Department of CAP, NIMHANS, Bengaluru, [email protected]
Part 1. OCD in Children and Adolescents - Anything New?
Obsessive Compulsive Disorder (OCD) is today one of the most prevalent psychiatric disorders affecting children and adolescents, among the 10 leading causes of global disability. OCD was rarely diagnosed in children and adolescents until recently. It is now well known that a large number of youngsters are silent sufferers of this potential treatable disorder. Nevertheless, symptoms of OCD are poorly recognized, and undertreated even when recognized.
The availability of effective treatments for OCD now has impacted the outcome. Certain groundbreaking aspects of newly available information will be discussed in this symposium on OCD and Related Disorders.
Part 2. Childhood OCD and Neurodevelopmental Comorbidity
Obsessive Compulsive Disorder (OCD) is quintessentially a neuropsychiatric disorder that fits into a 'spectrum-construct'. In children with one or more neurodevelopmental disorders, there is emerging evidence of a greater co-occurrence of OCD, of a greater relatedness.
The complications in the evaluation, diagnosis and management of OCD in children arise primarily from this relatedness of OCD to other psychiatric disorders, chiefly neurodevelopmental. The current shift represents the application of findings from research in genetics and neuroimaging into the diagnosis and treatment of OCD and comorbidities in children.
Therefore, identifying comorbidities, especially neurodevelopmental, by deliberately looking for them is important in pediatric OCD.
Keywords: OCD, spectrum-construct, child and adolescent psychiatry
Leadership Skills for Psychiatrists
*President Elect of the World Psychiatric Association, professor of mental health and diversity at the Institute of Psychiatry at King's College, London, [email protected]
Course description: Doctors are expected to take on leadership roles but often receive very little or no training. A leader requires to have good communication skills, manage resources, and demonstrate vision and passion. Medical leadership is crucial in planning, developing and delivering best and most suitable services that psychiatric patients need and deserve.
The proposed course is about medical Leadership, which differs from management and is a different role which requires special skills. Are leaders born or made? Undoubtedly, some personality styles are a result of development, but other skills can be gained by training. The ability to manage people, deal with conflicts and develop a strategic vision for a service or organisation can all be learnt.
The course will allow trainees and early career psychiatrists to gain relevant skills, teach them how to use these skills and training in order to take on leadership roles in clinical and organisational settings. The course will focus on Leadership in a broad context. Clinicians need to learn how to influence policy makers and how to work with stakeholders to ensure that services are adequately funded and are acceptable to patients and their families. Although leadership is required across all medical disciplines, there are requirements which are specific to the field of mental health, which has the additional challenges of overcoming stigma and discrimination, barriers to care pathways, poor access to services and low acceptability.
Course outcomes: The course aims to provide an understanding of theories about leadership; to experience the skills required to negotiate, manage time and manage people; and to understand the qualities required for good leadership.
Keywords: Leadership skills, special skills, good leadership
"Digital Health Care in Psychiatry: Pros and Cons"
K. Ashok Reddy*, K. Jayaprakashan, Vadlamani Naresh.
*Principal, Govt. Medical College, Mahabubnagar,T.S & President IPS-SZ Branch
The digital and communication revolution is the defining feature of 21 st century. It is the driving force behind present economic and social changes. Every field of knowledge and all branches of science are embracing digital technology.
What is the scope of psychiatry in using this vast technology? How is it going to benefit the new research and understanding of mental health?
What will be the impact of technology on our profession?
What are going to be the benefits to the patient?
How much the technology can help in the communications between psychiatrist and clients?
What are the troubles and caveats that need to be cautious about?
What are the disadvantages digital technology?
This will be discussed and debated in the symposium.
Keywords: Digital Health care, technology, Pros and Cons
Spirituality and Mental Health
Section 1: The science of spirituality
The concept of personal God versus impersonal God, Consciousness primary or matter is primary. The conflict of science and spirituality. Evidence of rebirth and what is carried with the soul at the time of death. The law of karma and how its evaluated on the basis of our spiritual evolution. Evolution of our consciousness and the basis of the cycle of rebirth. The journey of the soul after death and the concept of ghosts and spirits, Are these real? Evidence and ten commonly asked questions by our clients answered. In this connection, the issue of cremation versus burial is explored. The issue of vegetarianism briefly touched upon as a tool in the spiritual journey.
Section 2: The human Mind, The Unconscious, The functions of the EGO.
Evolution of the human brain from the reptilian to the mammalian and now the human brain (The structural development). Mind - their conscious, their unconscious, their structure, their contents. The self the false self (EGO) and the true self (spirit) witnessing presence and consciousness. How the ego conditioned by society, religions, parents and education controls our lives and how the spirit which is the basis for human evolutions is neglected and unnoticed. The spiritual journey is to stay in the spirit is to become aware and use the mind as the tool and not be used by the mind. Once a witnessing presence is brought to life the human reaction to life is replaced by response which is most relevant and appropriate to the present moment. This is done only after cleansing the negative emotions of the individual where he is greatful for every moment of his life and start seeing the positives in life. He sees that every problem as an inbuilt solution and is able to look at the solution by experiencing the problem and not resisting it. The problem seizes to be the problem because the learning experience of each problem allows the individual to mature and evolve. Problem solving becomes a process of,
- Repairing - Re- Pairing
- Recognition - Re - Cognition
- Relieving - Re - Living
The above 3 processes, are the techniques employed in clinical practice by questioning the reality of thoughts, emotions and experiences in the present moment. When it is realized that the past fears and future projections are illusions in the present moment the illusionary fabric dissolves. The moment it dissolves, on experiences relief and peace in the present moment.
Section 3: Work of Byron Katie, The 4 questions and turn around, Technique to clear the unconscious beliefs one at a time by questioning the reality in the present moment.
The work of Byron Katie and examples of her sessions are presented. Worksheets on her work is presented and supplied to participants. The process of her work and enquiry is meditative in nature.
Adding meditation to life you may get better health and sleep as a side effect, but if you make life meditative you have peace, contentment and bliss.
Community psychiatric care: Resource pooling, a master-plan for the voluntary sector
Jyothi Arayambath*, Manoj Kumar, Sivakumar Thanapal
* Psychiatrist, Lincolnshire Partnership NHS Foundation Trust, UK, Managing Trustee, MHAT-UK, [email protected]
Health care spending, especially for mental health is limited and on the decline, all over the world, especially in low and middle income countries like India, even though the demand is on the increase.
Innovative and creative models spring up across the world to address various local as well as global problems which are often deemed replicable.
Sharing and pooling of resources and the know-how should therefore become the main stay of such developments within and outside voluntary organisations, linking up with various other groups and funding bodies to produce a platform for the delivery of comprehensive care.
There are several successful models across the world in social, economic and health care sectors and we should devise a system of guiding and signposting various potential collaborators in the field.
For the governments, in the context of managing chronic illnesses, especially mental illness, the idea of a long term monitoring could seem an unnecessary spend, considering the potential for relapse, stigma and associated reduction in employability.
A holistic approach without isolating healthcare, especially mental health care, with a concept of the broader definition of well being and quality of life should be adapted for sustainability.
Compassionate care is sustainable in the long run; but generating revenue in short term, enabling people, facilitating recovery which is focused on the community participation, all remain a major challenge.
In this context an alternative model for re-integration becomes important where the communities look after their own by getting them back to the society and work, ultimately helping them rebuild their lives.
Resource pooling would open up new possibilities for non-governmental and governmental organisations as well as the corporate organisations with a view for social welfare, to amalgamate various operational strategies to deliver simple solutions for the long run, ensuring sustainability.
This symposium explores principles and examples of models of care delivery of sharing and pooling expertise, money and other resources, by applying the concepts to adapt to different settings in times of austerity and crisis. As we move towards integrating mental health care delivery with delivery of care for non-communicable diseases, it is time that we explored new ways of working in the community. Models of decentralised person-centred care as opposed to disease-specific care need to be understood and disseminated and this symposium will aim to do that.
Keywords: Community Psychiatric care, Resource pooling, austerity and crisis
Forensic Psychiatric Practice: Canadian Perspective
The authors will present the process of fitness and the criminal responsibility assessments within the criminal justice system in Ontario, Canada. All other provinces and the Territories in Canada follow the same procedures under the provisions of the Criminal Code of Canada. Then they will discuss the supervision and management of those offenders found Unfit-to-stand trial and Not-Criminally-Responsible due to Mental Disorder (NCR) under the jurisdiction of the Ontario Review Board. Every province and the Territories have similar Review Boards appointed by the Minister of Health of the Provinces and the Territories. The last part of the presentation is on the procedures adopted by the Youth Justice System in Canada to deal with mentally disordered youth offenders.
Topic: INDIAN THEORIES AND CONCEPTS RELEVANT TO BEHAVIORAL SCIENCES
Broad Introduction of the Subject: by Prabhakar Korada
The ANCIENT THEORIES: Prabhakar Korada
The ENERGY MERIDIANS: B. N. Gangadhar
The ROAD to MENTAL HEALTH: A. Jagadish
SOLACE TO THE TERMINALLY ILL and their FAMILIES: Thanatology: B. R. Ravishankar Rao
The DEVELOPMENT OF PERSONALITY: Cherukuri Harihar
Symposium - Biological psychiatry
P. K Singh
" Membrane dysfunctions in Schizophrenia"
" Genome dysfunctions in Schizophrenia"
" Neurochemistry of acquired resistance to Antipsychotics"
Symposium - Military Psychiatry
- Behavioral Addiction Clinic :Need or Hype
Epideomology of Behavioral addictions: J Gambhir
Course and outcome of behavioural addictions: Vinay Chauhan
Management and medicolegal issues in Behavioral addictions: A Saxena
- Amar, Akbar & Anthony :Cultural underpinnings of behaviour
Psychiatric Lessons from Hinduism: Chadrashekhar
Psychiatric Lessons from Islam: Shahbaaj Khan
Psychiatric lessons from Christianity: Pankaj Sharma
- Prediction of Addiction :Man with spirit
Psychological Predictors of Substance Abuse: A Saha
Social predictors of Substance abuse: Virender Vikram
Biological predictors of substance abuse: Ankit
- Combat psychiatry : Perspectives of Army/Navy/Air Force:
Perspectives from the Land: Vinay Chauhan
Perspectives from the Air: A K Gupta
Perspectives from the Sea: Chaitanya Kodange
- Slaves of the screen : Symposium by the residents of AFMC- Pune
Introduction and prevalence: Rajat Garg
Early identification: Neha Sharma
Management: Manisha Jindal
Prevention: Jithin Raj
'Yoga and Meditation'
P Kishan*, B N Gangadher
*Convener, IPS Task Force on yoga and meditation
Title: Psychiatric Morbidity At Work Place
Indira Sharma and Nilesh Shah
Format of Workshop:
Impact of Psychiatric morbidity at work place by Nilesh Shah:
Presentation of case vignettes:
Case vignette of an employee
Case vignette of an employer by Indira Sharma:
Case vignette of an employee
Case vignette of an employer by Nilesh Shah:
Group discussions: by Indira Sharma & Nilesh Shah:
Summary of discussion: by Indira Sharma:
WPA Symposium on Rural Global Mental Health
Prakash B. Behere (India): Rural Mental Health Services in Rural India, [email protected]
Anshuman Pant (Australia): Rural Mental Health Services in Australia
Vimal Kumar Sharma (U. K): Ways and Methods to Reach out to Rural Communities
WPA Symposium - Human sexuality section
Endocrinology and Practical implications in Sexual Medicine Practice
T.S. Sathyanarayana Rao
Professor, Department of Psychiatry, JSS Medical College, JSS University, Mysuru, Karnataka. [email protected]
TESTOSTERONE - Mrugesh Vaishnav, Ahmedabad
OXYTOCIN - T.S.S. Rao, Mysore.
Neuroendocrinology is concerned with the relationships between the central nervous system and the endocrine system. Hormones play a very important role in the developmental anatomy, physiology and the behavior. The interaction between various hormones effect and modulate sexual behavior and play a prominent role in gender and sex differences. The symposium looks into the effect of two very important Hormones - Testosterone and Oxytocin in individuals sex life with special reference to male and female sex end behaviors.
Keywords: Neuroendocrinology, Testosterone, Oxytocin.
Sexuality Speciality Section Symposium
Humour as a learning tool in Sex therapy: Based on anecdotal experiences
T.S. Sathyanarayana Rao and Vihang N. Vahia
Professor, Department of Psychiatry, JSS Medical College, JSS University, Mysuru, [email protected]
Humour has a significant role in every individuals life and researchers have documented many beneficial effects of the same. However, it could be a source of learning experience. Practice of sexual medicine and mastery of art and science of sex, gender and behavior problems in clinics involves many trial-and-error experiences. Clinicians have documented success and failure in their clinical practice atleast in the initial periods which helped them mature as professionals. Understanding anatomy, physiology and psychology of sex involves utmost sensitivity. The symposium highlights the journey involved and lessons learnt through the medium of humour and anecdotal experiences.
Keywords: Humour, Sex therapy, Gender.
Symposium on GMHAT
Global Mental Health Assessment Tool (GMHAT)"
Suyash Sinha, P B Behere, Wardha, India: Use of Global Mental Health Assessment Tool Global Mental Health Assessment Tool (GMHAT/PC) in Primary Care and General Health Settings in India
Anweshak Das, P B Behere, Wardha, India: Prevalence of Psychiatric Morbidity in Undergraduate MBBS Students of Rural Medical School in Central India using Global Mental Health Assessment Tool (GMHAT/PC)
Vimal Sharma: Global Mental Health Assessment Tool GMHAT/PC for International Communities
Vaishali Tendolkar, P. B. Behere, Wardha, India: Validity of Marathi Version of Global Mental Health Assessment Tool (GMHAT /PC) for diagnosis of persons with Psychiatric illness from rural Maharashtra
Vishal Shah, P. B Behere, Wardha, India: Psychiatric morbidity among spouses of men with Alcohol Dependence Syndrome
Murali Krishna, Mysore, India: GMHAT in Elderly Population
Lokendra Sharma, Jaipur, India: GMHAT for Undergraduate Medical Education
IPS Child Psychiatry Specialty Section Symposium 2016
"Next Big Thing in Child and Adolescent Psychiatry"
Part 1. OCD in Children and Adolescents - Anything New?
Shoba Srinath, NIMHANS, Bengaluru
Obsessive Compulsive Disorder (OCD) is today one of the most prevalent psychiatric disorders affecting children and adolescents, among the 10 leading causes of global disability. OCD was rarely diagnosed in children and adolescents until recently. It is now well known that a large number of youngsters are silent sufferers of this potential treatable disorder. Nevertheless, symptoms of OCD are poorly recognized, and undertreated even when recognized.
The availability of effective treatments for OCD now has impacted the outcome. Certain groundbreaking aspects of newly available information will be discussed in this symposium on OCD and Related Disorders.
Part 2. Childhood OCD and Neurodevelopmental Comorbidity
Johann Philip, Peejays CGC @ the Neurocenter, Cochin
Obsessive Compulsive Disorder (OCD) is quintessentially a neuropsychiatric disorder that fits into a 'spectrum-construct'. In children with one or more neurodevelopmental disorders, there is emerging evidence of a greater co-occurrence of OCD, of a greater relatedness.
The complications in the evaluation, diagnosis and management of OCD in children arise primarily from this relatedness of OCD to other psychiatric disorders, chiefly neurodevelopmental. The current shift represents the application of findings from research in genetics and neuroimaging into the diagnosis and treatment of OCD and comorbidities in children.
Therefore, identifying comorbidities, especially neurodevelopmental, by deliberately looking for them is important in pediatric OCD.
This symposium is an attempt to emphasise these clinical associations, and the need to manage these comorbidities.
Workshop on Bedside Teaching
Source of Support: None, Conflict of Interest: None