Darpan Kaur

Psychological impact of adult alcoholism on spouses and children

Chronic alcoholism can have an adverse psychological impact on the family involved in caregiving and coping with the alcoholic. This article attempts to review and discuss relevant literature pertaining to the overall psychological impact of adult alcoholism on spouses and children. A literature search on various search engines like Pubmed, Psychinfo, OmniMedicalSearch, and WebMD was done using search words such as psychological impact, alcoholism, family spouse, parents, and children. The articles perceived to be relevant have been reviewed and discussed. The literature search revealed significant problems in coping among family members. It was found that there exists a huge burden on the immediate family members of the chronic alcoholic. Recent studies have found high levels of psychological stress and depressive symptoms in spouses of alcoholics. Alcohol use has also been significantly linked to aggressive behaviors and intimate partner violence. Parentification and emotional caretaking were found in the children of chronic alcoholics. This can have a major impact on the psychological development of these children. Recent studies have shown that the offsprings of alcoholics are at a high risk for Conduct Disorders, Attention Deficit Hyperactivity Disorder, Major Depressive Disorder, and Substance Dependence. Marital and Family therapy may have a role in therapeutic as well as preventive care approaches in alcoholism.

Stigma experienced by caregivers of patients with severe mental disorders: A nationwide multicentric study

Background: Stigma is very common among caregivers of patients with severe mental disorder; however, there is lack of national level data from India. Aim: To assess affiliate stigma and its correlates among caregivers of patients with severe mental disorders. Method: For this, caregivers of patients with schizophrenia (N = 707), bipolar disorder (N = 344) and recurrent depressive disorder (N = 352) were assessed on Stigma scale for Caregivers of People with Mental Illness and General Health Questionnaire. Results: Caregivers of patients with schizophrenia reported significantly higher stigma than patients with bipolar disorder and recurrent depressive disorder. Caregiver of patients with bipolar disorder reported significantly greater stigma than the caregivers of patients with recurrent depressive disorder. Higher caregiver stigma in all the diagnostic groups was associated with higher psychological morbidity in caregivers. Higher stigma in caregivers of schizophrenia was seen when the patient had younger age of onset and longer duration of treatment. In the bipolar disorder group, higher stigma in caregivers was seen when patient had higher residual manic symptoms. Conclusion: This study suggests that caregivers of patients with schizophrenia experience higher stigma than the caregivers of patients with bipolar disorder and recurrent depressive disorder. Higher stigma is associated with higher psychological morbidity in the caregivers. Therefore, the clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the caregivers and plan intervention strategies to reduce stigma.

Patterns of Psychiatric Co-Morbidities In Patients of Hiv/Aids on Anti Retroviral Treatment

Back ground: WHO data highlights that globally 36.7 million people are living with HIV. There is sparse literature on mental health research in HIV /AIDS from developing countries such as India. Aims: To study patterns of psychiatric co-morbidities and associated factors in patients of HIV/AIDS on Anti retroviral treatment. Methods: This was an analysis of patients with diagnosis of HIV/AIDS on Anti retroviral treatment referred to psychiatry opd services.The duration of study was past one Year. Institution Ethics committee clearance was obtained and data was analyzed with SPSS 17 software. Variables such as demographic factors, co-morbid substance abuse, psychiatric co-morbidity, source of referral, neurological and medical co-morbidity, psychopharmacological and psychotherapeutic intervention were analyzed. Results: The study found 14 patients of HIV/AIDS patients who had been referred for outpatient psychiatric consultation over past 1 year, on regular anti retroviral treatment. Mean age of the sample was 47.8 years with equal sex profile. Around 57.2% patients were from urban areas and 42.8% of the patients were from rural areas. Majority (45.7%) of the patients were primary educated. Out of the sample 50.6% of the patients were married. Most common Neurological and medical co-morbidity were seizure(28.6%) and Tuberculosis(42.8%) respectively.Psychiatric diagnosis analysis revealed that 60.5% patients had Depressive disorders,21.5% had Psychosis (Organic Psychosis),7.1% had AIDS related dementia,7.1% had substance use with personality disorders and 3.8 % had a manic episode. Maximum source of referral were from department of medicine (35.7%) and NGO (28.6%). The most commonly prescribed drugs were Escitalopram (5 mg to 20 mg,60.3%), Olanzapine (5 mg to 20 mg,25.5%) Donepezil ( 5 mg to 23.5 mg,7.1% ) Sodium Valproate (500 mg to 1000 mg,7.1%). More than 80% of the patients received a combination of medications and counselling ,the type of counselling for psychological reference were supportive psychotherapy,cognitive behaviour therapy psychoeducational counselling and family therapy. Conclusion: Consultation Liaison psychiatry in arena of mental health and HIV/AIDS in terms of service development and utilization are needed.

Indian psychiatric society initiated travel fellowship training in psychiatry: A unique opportunity for young psychiatrists

Byline: Sujita. Kar, Darpan. Kaur Indian Psychiatric Society (IPS) is a powerful force in world psychiatry. Over the past several decades, it has reached several milestones; the latest of which is the initiation of Travel Fellowship Training for young faculties in psychiatry, within the country. The Committee for Research and Education Foundation and Training of IPS has started this Travel Fellowship Training for young life fellow/life ordinary member psychiatrists of IPS. This educational program focuses in strengthening the clinical skills of young psychiatrists in their areas of interest by undergoing training in any institute, within the country under the guidance of experts of the country. In the year, 2015 – IPS has awarded the travel fellowship to Dr. Darpan Kaur, Assistant Professor, Department of Psychiatry, MGM Medical College, Navi Mumbai, Maharashtra and Dr. Sujita Kumar Kar, Assistant Professor, Department of Psychiatry, King Georges Medical University, Lucknow, U.P. IPS has arranged all the logistics for travel (to and fro airfare in economic class), accommodation and facilitation of official processes at the training institute. In this report, Dr. Sujita Kumar Kar and Dr. Darpan Kaur share their experience of their fellowships. Dr. Sujita Kumar Kar had opted for the fellowship training on the “Brain Stimulation Techniques” from 23[sup]rd November 2015 to 5[sup]th December 2015 and Dr. Darpan Kaur had opted for the fellowship training in child and adolescent psychiatry from 1[sup]st to 15[sup]th November 2015. Dr. Sujita Kumar Kar undertook training at the Department of Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru under the mentorship of Prof. B. N. Gangadhar, Prof. Jagadisha Thirthalli, and Dr. Urvakhsh M. Mehta. In the 2 weeks training on “Brain Stimulation Techniques” at the NIMHANS, Bengaluru, the focus was to improve the clinical skills in the newer brain stimulation techniques like – repetitive Transcranial Magnetic Stimulation (rTMS), transcranial Direct Current Stimulation (tDCS), and some unique methods in electroconvulsive therapy (ECT) (especially bi-frontal and electroencephalogram [EEG] monitored ECT). With discussion with the mentors, the following schedule was drawn: *Observing different brain stimulation techniques such as rTMS, tDCS, ECT (especially bi-frontal and EEG monitored ECT) *Hands on training on these techniques *Discussion regarding difficult issues related to these techniques *Reading the resource materials provided *Writing two scientific papers *Making a presentation on a selected topic before completing the training. The trainee directly observed and conducted the hands-on administration of TMS sessions including neuro-navigation assisted rTMS, continuous and intermittent theta burst stimulation, and cerebellar TMS. He had observed tDCS procedure in patients with OCD, alcohol dependence (for anticraving purpose), and persistent auditory hallucination as well as EEG monitored ECT and bi-frontal ECT. Two academic articles are under preparation for publication. He presented a seminar on the topic, “efficacy and predictors of treatment response in rTMS in depression”. At the end of the fellowship, the trainee acquired skills to administer different types of TMS, tDCS, and ECT. He has also acquired knowledge about these brain-stimulation techniques including the potential of setting up similar laboratories elsewhere. He developed the competence of planning research using these techniques. The hospitality and support of the mentors, staff, and residents were unimaginable. Overall, it was a nice and memorable experience of academic, clinical learning which will be helpful in clinical practice, teaching as well as research collaboration. A travel fellowship program of short duration is an excellent opportunity of strong relevance to current generation psychiatrists to build up skills in their area of interest. …

Factors associated with organ donation

Dear Editor, Organ donation has evolved significantly from an experimental procedure to acceptable medical treatment for terminal illnesses. Despite these contemporary advances, there has been a relatively slow progress in the supply of organs for transplantation. This has resulted in global shortage of organs available for transplantation. There is a paucity of literature about the relationship between knowledge and attitudes toward organ donation. If barriers to the willingness for organ donation can be identified, these items can be targeted for change.[1] We conducted a literature search and identified numerous studies on factors associated with organ donation. We found many studies which assessed knowledge, attitudes, perceptions, and beliefs of health care professionals toward organ donation. We have attempted to summarize a few studies which we believe to have relevance regarding the same. Matten et al. interviewed nurses regarding organ donation and found that they were knowledgeable about organ donation and their attitudes were moderately positive. Factors that were significant were knowledge, attitudes, and beliefs about donation.[2] Wakefield et al. assessed the role of religious and ethnic views regarding organ donation amongst university students. They administered the Organ Donation Attitude Scale with measures assessing knowledge and attitude. They found that females, younger students, and those with higher knowledge levels were more likely to have attitudes that favored organ donation. They also found that students who described themselves as having stronger religious beliefs and those with poor knowledge had less favorable attitudes toward organ donation. They suggested that further in-depth research examining the impact of religion and culture was essential to explore strategies for improving organ donation.[3] Jelinek et al. administered an online questionnaire regarding organ donation to Australasian healthcare professionals. They found that most members supported organ donation and around a quarter of their staff had received no education about it.[4] Zampieron et al. conducted a survey on attitudes toward organ donation amongst undergraduate nursing students. They administered a self-rated quantitative questionnaire and the Organ Donation Attitude scale. They found no significant correlations between attitude toward organ-donation and the age and sex of the students. They concluded that awareness and attitude levels of nursing students toward organ donation was inadequate.[5] Siminoff et al. collected data regarding organ donation from health care professionals and family members of patients. Their study revealed that family and patient socio-demographics and prior knowledge of the patients’ wishes were significantly associated with willingness to donate. They suggested that public education is needed to modify attitudes about organ donation prior to a donation opportunity.[6] Ballala et al. assessed the knowledge, attitude, and practices regarding organ donation among Indian medical professionals. They administered a semi-structured questionnaire and found that 8% were unaware of the term “body donation” and 85% believed that donated bodies were misused. They also found that 22% physicians were willing to donate their bodies and 68% expected the public to do the same.[7] Eide et al. investigated the need for learning and communication of intensive care doctors and neurosurgeons toward organ donation. They found that more than half had little experience of organ donation or how to relate to the patients’ relatives. They also found that many doctors reported a need to learn more about the medical issues and communication skills associated with organ donation. They concluded that training programs should focus on communication regarding organ donation with the caregivers of patients.[8] Tam et al. administered a questionnaire regarding knowledge, attitudes and commitment toward organ donation to nursing students. They found that attitude and educational year of the students were strongly correlated with commitment toward organ donation. They concluded that educational materials may be provided to students to facilitate their attitudes toward organ donation.[9] Jeon et al. assessed the knowledge and attitudes of health care professionals regarding organ donation. They found that the knowledge and attitudes of health care professionals regarding brain death and organ retrieval was poor. They found that gender, age, marital status, education level, and job position were significant in the attitude scores while marital status and education level emerged significant in the scores on knowledge.[10] The reviewed literature suggests that health care professionals have poor knowledge and variable attitudes toward organ donation. We found differences in the methodology and measures in the studies that we reviewed. Certain studies used validated and reliable scales for assessment. However, few studies developed their own questionnaires for assessing knowledge and attitudes toward organ donation. Methods of data collection varied from telephone conversations, online surveys, face-to-face interviews to self-rated questionnaires. Background literature suggests the need for improving existing knowledge and communication skills of health care professionals regarding organ donation. We believe that cultural factors may also contribute toward attitudinal differences regarding organ donation. There is a need to explore the complex interplay of culture, religion, and spirituality in this arena.