Amresh Shrivastava

Neurocognition and hypothyroidism: Critical points

Hypothyroidism is a common medical condition associated with low thyroid hormone levels and has a large number of physical and neurocognitive symptoms that may manifest across life based on when` the disorder sets in.[1] The important point is that many of these neurocognitive deficits may, in fact, be reversible with the correction of thyroid abnormalities. The present editorial shall focus on neurocognitive aspects of hypothyroidism that are seen in adults and the diagnostic and confounding factors that surround the same. Clinically patients with neurocognitive deficits may be diagnosed and treated as either age-associated cognitive impairment, dementia, and depression without a proper assessment of thyroid function and hypothyroidism may thus carry on undiagnosed for a number of years.[2] It is of equal interest that symptoms of depression and neurocognitive deficits associated with hypothyroidism may show a mixed response to thyroid pharmacotherapy, and hence, it is all the more essential to clinically dissect and decipher the cause of such symptoms.[3]

RISK ASSESSMENT OF SUICIDE IN CLINICAL PRACTICE

Suicide is a global public health problem. Its management in clinical practice is complex and challenging .Studies show about 26% suicide in mental health system. Out of these, 14% commit suicide during hospital stay; about 50 90% have at least one psychiatric diagnosis. 60 70% of patients are hospitalized due to an attempt or potential crisis, about 15 20% attempt suicide prior to admission. Suicide is also common in post-discharge period. Every psychiatrist on an average loses atleast on client due to suicide in an average span of 20 years of practice. In about 70% of cases, suicide behavior is there as on for hospitalization in acute settings. Continuous training and skill development are two of the most important measures in clinical practice for dealing with suicide behavior. High suicide rates are reported in prodromal stage, acute illness, post-hospitalization and soon after discharge in the community. A clinician faces challenging situations while determining the level of care and referral for a patient with a high suicide potential. There is continued struggle amongst clinicians for decision-making in regards to the need for hospitalization, level of monitoring, voluntary status, and time of discharge. It is generally agreed that suicide is difficult to predict and prevent; however, in order to develop clinical excellence and offer a standard of care, continued education and knowledge translation for bringing research into practice is the least that can be done. Inspite of this need, continued education for mental health professionals and psychiatrists in-training remains limited. *Corresponding author: Amresh Shrivastava, Parkwood Institute, Mental health, 550 Wellington Road, London, ON N6C 0A7, Tel: (519) 646-6100; E-mail: dr.amresh@gmail.com Received Date: October 30, 2015 Accepted Date: November 29, 2016 Published Date: December 03, 2016

Mental Health Service Utilization by Referrals from a Helpline for Suicide Prevention in Mumbai, India

Background : Suicide is a global health problem which is highly underreported and under treated. Though suicide intervention helplines have been studied the pattern of utilization of a suicide helplines by those referred to the facility has not been studied. Methodology : In the present study we have studied the pattern of utilization of a helpline in a community mental health clinic in the city of Mumbai. The study sample was patients who called the helpline and later attended the out patient facility of the clinic. Data was collected in semi-structured format and statistically analyzed using computer software. Results : 15149 calls were received by the helpline. Of the 1391 patients reporting suicidal ideation (59.42%) only 718 opted for psychiatric evaluation. 18.3% of patients with suicidal ideas had a past suicidal attempt while 82.6% had a psychiatric diagnosis. Majority of patients were belonging to psychotic and mood disorder categories. Financial and educational stressors were reported as the main stressors leading to suicidal ideas. Conclusions : A helpline offers definite advantage for patients with suicidal ideation to access mental health services. A helpline is an economical service that serves as a contact point to bring more people at an early stage to mental health care facilities.

P03-132 - Redefining outcome measures in schizophrenia: integrating social & clinical parameters

Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when obtained from patients, relatives, caregivers, or professionals making it difficult to determine the level of recovery in patients. The reason for the lack of agreement may be due to the limitations of the measurement tools themselves, which are not comprehensive and may measure different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and in turn recovery requires development. Unfortunately for one of the above reasons or both, patients assessed as “recovered” remain excluded from mainstream society. We are of the opinion that this is the case because present outcome measures do not capture real-life situations. We propose that the concept of recovery should be carefully defined and that the gold standard of outcome should incorporate social and clinical parameters. We define recovery and discuss remission in full within the body of the paper. In short we propose that within the definition of recovery, personal growth, supportive relationships, and social inclusion should be incorporated. With the new definition the following will be addressed when assessing outcome: 1) Symptom manifestation, 2) Response to treatment, 3) Impact on self & others. We also hope that with a new definition the following three dimensions will be addressable: 1) Clinical remission, 2) Presence of side effects, 3) social outcome. Finally, the reassessment of recovery should be sensitive to culture, be comprehensive, and reliable.