Koushik Sinha Deb

Indian family systems, collectivistic society and psychotherapy

Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in todays changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.

Impact of alcohol use on thyroid function.

Alcohol is one of the commonest illicit psychoactive substances consumed globally and is the worlds third largest risk factor for disease and disability. It has been reported to have multiple effects on the hypothalamo-pituitary-thyroid axis and the functioning of the thyroid gland. It has been reported to cause direct suppression of thyroid function by cellular toxicity, and indirect suppression by blunting thyrotropin-releasing hormone response. It causes a decrease of peripheral thyroid hormones during chronic use and in withdrawal. Alcohol use may also confer some protective effect against thyroid nodularity, goiter, and thyroid cancer. This article presents a review of the clinically relevant effects of alcohol on the functioning of the thyroid gland and also discusses the effect of medication used in treatment of alcohol dependence on thyroid function.

Dhat syndrome: A review of the world literature

Dhat syndrome is described as a culture bound syndrome (CBS). There is an ongoing debate on the nosological status of CBS. Dhat syndrome has been found to be prevalent in different geographical regions of the world. It has been described in literature from China, Europe, Americas, and Russia at different points of time in history. Mention of semen as a “soul substance” could be found in the works of Galen and Aristotle who have explained the physical and psychological features associated with its loss. However, the current classification systems such as International Statistical Classification of Diseases and Related Health Conditions-10 (ICD-10) (World Health Organization (WHO)) and Diagnostic and Statistical Manual (DSM)-IV-TR (American Psychiatric Association) do not give guidelines to diagnose these culture-bound conditions in the main text. The revisions of these two most commonly used nosological systems (the ICD and DSM) are due in near future. The status of this condition in these upcoming revisions is likely to have important implications. The article reviews the existing literature on dhat syndrome.

Violence and mental illness: what is the true story?

In public perception, mental illness and violence remain inextricably intertwined, and much of the stigma associated with mental illness may be due to a tendency to conflate mental illness with the concept of dangerousness. This perception is further augmented by the media which sensationalises violent crimes committed by persons with mental illness, particularly mass shootings, and focuses on mental illness in such reports, ignoring the fact that most of the violence in society is caused by people without mental illness. This societal bias contributes to the stigma faced by those with a psychiatric diagnosis, which in turn contributes to non-disclosure of the mental illness and decreased treatment seeking,1 and also leads to discrimination against them. The association of violence and mental illness has received extensive attention and publicity. Public perception of the association between mental illness and violence seems to have fuelled the arguments for coerced treatment of patients with severe mental illness.2 ,3 However, this perception is not borne out by the research literature available on the subject. Those with mental illness make up a small proportion of violent offenders. A recent meta-analysis by Large et al 4 found that in order to prevent one stranger homicide, 35 000 patients with schizophrenia judged to be at high risk of violence would need to be detained. This clearly contradicts the general belief that patients with severe mental illness are a threat. There are numerous ways of conceptualising the definition of violence, although at present there is no consensus as to which of these is the most appropriate. The WHO has defined violence as ‘the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, …

Substance use in women: Current status and future directions.

Alcohol and substance use, until recently, were believed to be a predominantly male phenomenon. Only in the last few decades, attention has shifted to female drug use and its repercussions in women. As the numbers of female drug users continue to rise, studies attempt to understand gender-specific etiological factors, phenomenology, course and outcome, and issues related to treatment with the aim to develop more effective treatment programs. Research has primarily focused on alcohol and tobacco in women, and most of the literature is from the Western countries with data from developing countries like India being sparse. This review highlights the issues pertinent to alcohol and substance use in women with a special focus to the situation in India.

A study of disability and its correlates in somatization disorder.

OBJECTIVE The present study was conducted to assess disability, and its demographic and clinical correlates in patients suffering from somatization disorder. METHOD Sixty-six patients, diagnosed as somatization disorder according to ICD 10 Diagnostic Criteria for Research (ICD 10-DCR), were assessed for disability using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were also assessed for associated anxiety, depression, neuroticism and subjective distress using the Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), PGI Health Questionnaire N2 (PGIN2), and Visual Analog Scale, respectively. RESULTS Mean age of the sample was 34.5±5.8 years. Females constituted about 60% of the sample. Mean duration of illness was 9.14±4.13 years. More than 70% of the subjects suffered moderate to severe disability. Age, number of symptoms, duration of illness, and scores on HAM-A and HAM-D showed a positive correlation with disability. CONCLUSION Somatization disorder is associated with significant disability which increases with the number of somatic symptoms, duration of illness, associated depressive and anxiety symptoms.

Impact of tobacco on thyroid function

A psychoactive substance is any chemical that, upon consumption, leads to a state of intoxication and alteration of physiological functions. Tobacco is the most common licit psychoactive substances being used globally and is the biggest contributors to mortality and morbidity. Tobacco has multiple effects on the hypothalamic-pituitary-thyroid axis and the functioning of the thyroid gland. This article presents a review of the clinically relevant effects of tobacco on the hypothalamic-pituitary-thyroid axis. This review mainly focuses on clinical issues. Tobacco smoking modifies almost all functions of the thyroid gland.

Harmony : close knitted mhealth assistance for patients, caregivers and doctors for managing SMIs

Serious mental illnesses (SMIs) like depression, bipolar disorder, etc. are one of the dire health concerns throughout the world. According to WHO, depression is one of the prime causes of disability with 350 million people suffering from it globally. Patients with SMIs require prolonged care and management which in long term adversely affects the caregivers health. Existing studies leverage the potential of mobile technology to build healthcare systems for mental illnesses. Most of these studies are patient centric with an aim to assist patients in self-management of their illness. The studies focused only on patients have neither exploited the potential of caregivers role, nor have explored the solutions for managing their burden. We aim to provide a solution that leverage the role of caregivers in providing healthy cooperation between the patients and the doctors in managing SMIs. In this paper we present our work in progress --Harmony - a system designed to encourage the patients in adopting an efficient morning routine. Aim of the current prototype is to reduce the morning efforts of the caregiver by assisting the patient in becoming independent.

Restraint and seclusion in India

Psychiatric management in India often includes the practice of restraint and seclusion of violent and difficult to control patients, both in inpatient medical facilities and in places of traditional healing. However, without any informed guidelines and regulation, these practices have flourished from necessary last resort to accepted ways of control. The upcoming draft mental health bill have now provided with a set of basic guidelines for preventing restraint. The scientific literature is also sparse on the subject from India, despite a robust body of evidence being available from the Western literature. This review, summarizes the evidence from India, looks into the causes and outcomes of restraint and seclusion and also discusses methods and stratagems that might be beneficial for reducing restraint and seclusion in the country.

Orlistat abuse in a case of bulimia nervosa: the changing Indian society☆☆☆

Eating disorders like bulimia nervosa, generally considered to be rare in Asian countries, are currently on the rise among the youth, probably secondary to rapid westernization and globalization of the orient. Clinical manifestations of these disorders, which were previously thought to be different in the oriental countries, are now also often seen to parallel their western counterparts. However, detailed clinical descriptions of such cases from Asian countries, documenting the societal change, are missing. In addition, the possibility of abuse of various anti-obesity drugs as a part of bulimic compensatory behavior is high in this population, given the easy and unsupervised access of these drugs over the counter. We report a case of bulimia nervosa in a female medical graduate from India, presenting with classic bulimic symptomatology and with a compensatory behavior consisting almost exclusively of Orlistat abuse. This case sensitizes health professionals to the abuse liability of new medications like Orlistat and also documents the changing symptomatology of bulimia nervosa in India.