M Kishor

Mysore study: A study of suicide notes

Background: Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse. Objective: The aim was to study the themes in suicide notes that might be useful in prevention strategies. Materials and Methods: A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed. Results: A total of 22 suicide note were available. A majority of suicide note was in age group of 16–40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish. Conclusion: The majority of suicidal note contained “guilt” which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world.

Undergraduate psychiatry training in India; past, present, and future looking for solutions within constraints!!

Byline: M. Kishor, Mohan. Isaac, M. Ashok, Lakshmi. Pandit, T. Sathyanarayana Rao Psychiatric disorders are considered one of the leading causes of morbidity and mortality worldwide.[sup][1] They are closely associated with other medical conditions such as diabetes and hypertension, adversely affecting their outcome.[sup][2],[3] India has more than 1/6[sup]th of the global population, and is a rapidly developing country with enormous changes in all spheres of life. Mental health issues are gaining a great deal of importance, in keeping with other health issues, and are likely to play a key role in the diverse indicators of development. Suicide rates in India are reportedly one of the highest in the world and have already attracted political and socio-cultural trajectories in both causation and solutions for the problem, underplaying mental health causes for the same, as well as understating the inadequacy of mental health services in India.[sup][4] Concerns regarding the mental health scenario in India are directly related to a lack of awareness among the public and a lack of the minimal mandatory training in psychiatry for medical undergraduates, which has consistently produced thousands of doctors who are incompetent to diagnose and manage common conditions such as depression and suicide.[sup][5] Training undergraduates in the field of psychiatry can be considered as one of the most important pathways to improve mental health services in India. That undergraduate training in psychiatry is inadequate has been the contention from the first report of the subcommittee on undergraduate teaching in psychiatry, Indian Psychiatry Society (1965).[sup][6] The emphasis has been on inadequate hours of training in psychiatry as well as a lack of the required trained staff. Painfully, despite the numerous evidences about benefits of undergraduate psychiatry training [sup][7],[8],[9] nothing seems to have changed in this half of the century (1965–2015) as the Medical Council of India is reluctant to make psychiatry a mandatory subject for the MBBS examination,[sup][10] impairing the mental health component of basic health services in India. This great lacuna in Indian medical education is likely to have an adverse effect on mental health services for the next few decades. In addition is the issue that India has a large deficit of psychiatrists with just 0.3 for 100,000 populations, as mentioned in world mental health atlas 2014.[sup][11] To address this challenge, we may have to look for solutions that enable us to attract medical students to the subject of psychiatry, and build psychiatric knowledge and skill in them through diverse ways. The onus for achieving this lies on each faculty and the department as a team, the policies of the Institution and University to which they belong, as well as professional bodies like the Indian Psychiatric Society, each of whom will have a major role to play. The efforts of Indian Psychiatry Society have been well-summarized by Dr. Roy Abraham Kallivayalil in his presidential address at ANCIPS 2012, Kochi. The Medical Council of India had made it mandatory for all medical colleges to have a department of psychiatry as a part of teaching hospitals, providing mental health services in a general hospital setting. Needless to say, most nonteaching hospitals in India, public or private, do not have psychiatric services on a regular basis. Hence, medical colleges are crucial centers for providing Mental Health Services. Currently, there are 412 medical colleges in India with 52,325 MBBS seats.[sup][12] The onus of training these medical graduates in psychiatry for whom the subject is not mandatory, as in, not assessed in the current examination system, lies with the faculty in psychiatry, they have to use their knowledge and passion in delivering psychiatric training for these students. Departments that have recognized postgraduate seats must also put in the same degree of effort in teaching the undergraduates. …

A compulsion to throw away prescribed tablets in a case of childhood obsessive-compulsive disorder with attention deficit hyperkinetic disorder

Obsessive-compulsive disorder (OCD) is one of the most complex and disabling disorders presenting to a hospital setting. Its symptomatology can mimic other psychiatric disorders, especially in children, making it confusing for the treatment team. It is often associated with comorbidities such as tics, depression, and attention deficit hyperactivity disorder (ADHD). We hereby report an instance of ADHD-OCD co-occurrence in a 16-year-old boy, who presented with a 9-year history of restlessness, obsessions of contamination, symmetry, causing harm to others, setting fire, magical thoughts, with compulsions of washing, checking, ordering and arranging, counting and repeating, swallowing stones, mental rituals, and self-mutilating behavior. Independent of these repetitive rituals, there were multiple instances throughout his schooling where he would be in disciplinary trouble due to his hyperactivity, disorganization, and inattentiveness. The resulting distress from all the above symptomatology had led to two suicidal attempts. His presentation to us was the index presentation to a psychiatric setting, and following initiation of treatment, he developed a compulsion to throw away his prescribed tablets. The interesting aspects of the phenomenology and management will be discussed.

Economic costs of adverse drug reaction: Concerns in methodology

247 Sir, Jisha[1] described an observational study regarding the economic impact and severity of adverse drug reactions (ADRs) in patients with mental illness in a tertiary care hospital in south India. We would like to acknowledge the authors for evaluation of this clinically relevant yet a largely unexplored area. However, we would like to highlight concerns regarding the casual manner in which the methodology was undertaken overlooking important confounding factors as well as the misleading interpretations.

An innovative concept book guide for MBBS students

The suggestion that education be categorized is suitable for administrative or everyday descriptive contexts. It is incorrect when education is treated as an independent variable the effect of which on outcomes is intended to be studied using inferential statistical procedures. The reasons were stated in my earlier article.[2] Operationalizing education in years is particularly useful when subjects complete extra courses, training, or diplomas at a horizontal level without gaining an additional degree.

Doctors interested in alternative learning: JSS DIAL - An innovative facility by the doctors for the doctors!!

Indian Journal of Psychiatry Volume 59, Issue 3, July-September 2017 403 visit at urban health center helped me to gain insight into community-based research on perinatal mental health issues. As a part of social responsibility, perinatal psychiatry team, NIMHANS, have undertaken an incredible initiative of developing series of videos for increasing awareness of perinatal mental health issues among the medical officers, which is a very important educational tool.

Use of Google Maps to target public awareness – A pilot retrospective study at tertiary hospital

Having read the correspondence regarding the description and adaptation of the survey used in the article contributed by Zieger I would like to take the opportunity to respond on behalf of all the authors and provide some clarification. In the study, we sought to assess the perception of stigma regarding mental illness in two Indian cities, Chennai and Kolkata. In response to each of the points raised: 1. While the survey was developed in English, it was translated directly into the respective local languages before the participants were interviewed. This included Tamil for Chennai and Bengali for Kolkata. Each questionnaire contained the questions printed in both English and the respective language, providing a basis of accuracy and consistency for the interviewer. All participants included in the study were fluent in English or one of the regional languages (Bengali/Tamil). No participants were included or excluded based on the linguistic criteria. 2. In case participants were unsure of questions or contexts and needed more information and clarification, further information was provided to them after the initial interview, at which time questionnaire was then completed. Our impression was that during the interview if any issues arose due to some participants being unfamiliar with the context of mental illness, it was helpful that we allowed them to take their time and instructed them that they had the chance to respond to that question later. This procedure may not necessarily be a weakness of the questionnaire and facilitated a higher completion rate. 3. We agree et al.,[1,2] that in our study we did not fully follow the outlined WHO translation method, especially in terms of cognitive testing. We, thus, acknowledge the suggestion for future studies, given sufficient funding, and accept a potential inadequacy of equivalence as a limitation of our study. How to cite this article: Zieger A. Response to “Pretesting and cognitive interviewing are integral parts in translation of survey instrument”. Indian J Psychiatry 2017;59:253.

One year of innovative services: Library for patients and their caregivers in the psychiatry ward

1. Medical Council of India (MCI) 2017. Annual Report 2015‐2016. Available from: https://www.mciindia.org/ActivitiWebClient/informationdesk/ proceduretoIncreaseAdmissionCapacity. [Last accessed on 2017 Nov 15]. 2. Kishor M, Vinay HR. Innovative ways and customizing psychiatry training for undergraduates. Indian J Psychiatry 2015;57:431‐3. 3. Langendyk V, Mason G, Wang S. How do medical educators design a curriculum that facilitates student learning about professionalism? Int J Med Educ 2016;7:32‐43. one piece of advice that makes them reflect harder, dig deeper, and it led to some truly extraordinary answers.