Raman Deep Pattanayak

Neuropsychological performance in euthymic Indian patients with bipolar disorder type I: Correlation between quality of life and global functioning

This study aims to assess the neuropsychological performance, quality of life (QoL) and global functioning in euthymic patients and healthy controls. It also explores the hypothesis that poorer cognitive performance will adversely influence the QoL of patients with bipolar disorder.

Help-seeking Behaviors Among Caregivers of Schizophrenia and other Psychotic Patients: A Hospital-based Study in Two Geographically and Culturally Distinct Indian Cities.

Background: India is a country of several diversities and cultures, which may influence the help-seeking behavior of mentally ill patients and families. Only a few Indian studies have focused on help seeking, especially for severe mental disorders. Objective: The study aimed to describe and compare the help-seeking behaviors among caregivers of psychotic patients visiting psychiatric clinics at two distinct cities of India. Materials and Methods: This was a cross-sectional exploratory study of key caregivers (N=50) of patients with a DSM-IV TR diagnosis of schizophrenia and other psychotic disorders, visiting psychiatric out-patient departments of VIMHANS, New Delhi, and CIMS, Bilaspur, Chhattisgarh. After due informed consent was taken, a semi-structured proforma was administered for socio-demographic profile, illness details, causative beliefs, and information on help seeking. Results: Supernatural forces were held responsible by 40% of the Bilaspur sample in contrast to 8% in New Delhi sample. Faith-healers were initial contacts for 56% and 64% of sample, respectively, at New Delhi and Bilaspur. Faith-healers followed by a psychiatrist formed the commonest pathway of care at both centers (32% and 36%, respectively). The sample at New Delhi spent significantly more money (median:

Assessment of burden in caregivers of Alzheimer's disease from India

4000 vs.

Perceived health risks, attitude and readiness to quit tobacco among euthymic bipolar disorder patients in regular contact with mental health services: An exploratory study from India

10) and traveled greater distances (median: 35 km vs. 10 km) for faith-healers during the course of illness. Two-thirds of sample in New Delhi and one-third at Bilaspur were aware of the nearby psychiatrist at the time of initial help seeking; however, only 28% and 12%, respectively, chose psychiatrist as an initial contact. The New Delhi sample reported a fear of medication adverse effects and stigma as perceived disadvantages of psychiatric help. The median time lost at both the centers was 1 month, with a maximum of 8.4 years in New Delhi and 4.9 years in Bilaspur. Of the total, 16% caregivers at New Delhi and 32% at Bilaspur center reported an intention to continue with faith-healing practices alongside psychiatric care. Conclusion: In spite of differing causal attributions, the patients and families across these cities may not be as different when it comes to behaviors related to help seeking for mental illness. Future large-scale studies across various regions of India may help in determining sociocultural and regional patterns of help seeking in greater detail.

(De-) criminalization of attempted suicide in India: A review

INTRODUCTION Most of existing literature on dementia caregiving comes from Western countries but the caregiving experience appears to vary in different societies. The cultural norms and socioeconomic resources of India are in stark contrast to western societies, however the dementia caregiver burden remains understudied in Indian context. AIM We aim to assess the burden in relation to key variables and explore its predictors in caregivers of Alzheimers disease. METHOD Thirty-two patient-caregiver dyads were selected. The dementia characteristics were assessed with Hindi Mental State Examination and Clinical Dementia Rating; burden was evaluated using Burden Assessment Schedule. RESULTS The caregiver sample had an overall moderate degree of burden. The burden in patients behavior and external support area increased with the degree of cognitive impairment. Caregivers for male patients were found to have a higher burden. The female caregivers perceived higher burden in physical and mental health, spouse related and caregivers routine. The burden in caregivers from joint families did not differ from nuclear families except for a lower burden in external support area. On stepwise multiple regression, spousal relation, HMSE score and male patient emerged as significant predictors of total burden. CONCLUSION There is a need to devote more research attention towards dementia caregivers from developing countries and to understand the culture-specific impact of caregiving.

Twelve-month prevalence and treatment gap for common mental disorders: Findings from a large-scale epidemiological survey in India.

Background Patients with bipolar disorder (BD) are at higher risk of tobacco-related harm compared with general population. However, they may not fully appreciate health risks even when asymptomatic. Aim: The study aims to explore the perceived health risks, attitude and readiness to quit tobacco among euthymic BD patients. Method The adult male outpatients with Diagnostic and Statistical Manual, 4th edition diagnosis of BD type I and nicotine dependence were selected if they were euthymic and in regular psychiatric follow-up (n = 50). They were assessed using Fagerstrom scale for nicotine dependence, transtheoretical model and a semi-structured questionnaire. Results The sample was unaware of the full spectrum of tobacco health risks and most of patients could report only one or two tobacco-related diseases. Though the majority correctly recalled the pack health warning, but felt that it should not be taken seriously. The sample perceived its own cancer risk to be lower than that of an average user of similar age. The non-readiness to change tobacco use was predicted by difficulty in quitting due to mood disorder (odds ratio (OR) 0.229) and a higher perceived ability to quit (OR 0.328). Conclusion The knowledge and risk perception for tobacco remains inadequate even among the stable BD type I patients in regular contact with mental health services.

Comparison of self-report and biological measures for alcohol, tobacco and illicit drug use in consecutive alcohol-dependent patients visiting a tertiary care centre

Attempted suicide is a serious problem requiring mental health interventions, but it continues to be treated as a criminal offence under the section 309 of Indian Penal Code. The article reviews the international legal perspective across various regions of the world, discusses the unintended consequences of section 309 IPC and highlights the need for decriminalization of attempted suicide in India. The Mental Health Care Bill, 2013, still under consideration in the Rajya Sabha (upper house), has proposed that attempted suicide should not be criminally prosecuted. Decriminalization of suicidal attempt will serve to cut down the undue stigma and avoid punishment in the aftermath of incident, and lead to a more accurate collection of suicide-related statistics. From a policy perspective, it will further emphasize the urgent need to develop a framework to deliver mental health services to all those who attempt suicide.

Reliability of Self-Reported Tobacco Use in Bipolar Disorder: An Exploratory Study of Euthymic Patients Visiting a Tertiary Care Hospital in India

Background: Common mental disorders, such as mood, anxiety, and substance use disorders, are significant contributors to disability globally, including India. Available research is, however, limited by methodological issues and heterogeneities. Aim: The present paper focuses on the 12-month prevalence and 12-month treatment for anxiety, mood, and substance use disorders in India. Materials and Methods: As part of the World Health Organization World Mental Health (WMH) Survey Initiative, in India, the study was conducted at eleven sites. However, the current study focuses on the household sample of 24,371 adults (≥18 years) of eight districts of different states, covering rural and urban areas. Respondents were interviewed face-to-face using the WMH Composite International Diagnostic Interview after translation and country-specific adaptations. Diagnoses were generated as per the International Classification of Diseases, 10th edition, Diagnostic Criteria for Research. Results: Nearly 49.3% of the sample included males. The 12-month prevalence of common mental disorders was 5.52% - anxiety disorders (3.41%), mood disorders (1.44%), and substance use disorders (1.18%). Females had a relatively higher prevalence of anxiety and mood disorders, and lower prevalence of substance use disorders than males. The 12-month treatment for people with common mental disorders was 5.09% (range 1.66%–11.55% for individual disorders). The survey revealed a huge treatment gap of 95%, with only 5 out of 100 individuals with common mental disorders receiving any treatment over the past year. Conclusion: The survey provides valuable data to understand the mental health needs and treatment gaps in the Indian population. Despite the 12-month prevalence study being restricted to selected mental disorders, these estimates are likely to be conservative due to under-reporting or inadequate detection due to cultural factors.

Clinical profile of mood disorders in children.

Background: Alcohol is a major drug of abuse in patients visiting treatment centres. The self-report is used by clinicians to collect information; however, alcohol-dependent patients may not provide reliable self-reports. Aim: The study aimed to assess the agreement between urinalysis and self-report for licit and illicit drug use in alcohol-dependent patients and to examine the relationship of biochemical measures with self-reported alcohol consumption. Methods: Consecutive patients (N = 199) with current alcohol use fulfilling Diagnostic and Statistical Manual, 4th edition (DSM-IV) criteria for alcohol dependence were included. Recent alcohol and drug use was enquired using a structured questionnaire. The biological measures included urine drug analysis and biochemical liver function tests. Results: Urinalysis revealed the use of opiates, cannabis, nicotine and benzodiazepines in 2.5%, 4.2%, 5.9% and 28.8%, respectively, even though patients reported no use of these drugs. Gamma-glutamyl transferase (GGT) was elevated in 95.2% of patients with self-reported heavy alcohol consumption, whereas it was raised in 60–62.5% of those with low to moderate alcohol use. In heavy drinkers, the biochemical liver markers appeared to corroborate with self-reported alcohol use. Conclusion: This study urges for the use of objective methods to validate the self-report in alcohol-dependent patients, especially for co-occurring nonprescription benzodiazepine and drug use.

A qualitative study of perceptions related to family risk of bipolar disorder among patients and family members from India

Background: Unlike schizophrenia, only a little attention has been paid to tobacco dependence in patients with bipolar disorder despite a similarly high prevalence and predisposition to health risks. The euthymic phase is especially suitable for tobacco screening by the treating psychiatrist. However, the validity of self-report for tobacco use in this patient population remains undetermined. Aim: The current study aims to assess the validity of self-reported tobacco use in euthymic bipolar disorder. Method: The psychiatric out-patients with DSM-IV TR diagnosis of bipolar type-I in remission who were males, ⩾ 18 years, and euthymic as established by current scores of < 7 on HAM-D and < 4 on YMRS. Patients were specifically asked for the recent use of tobacco in any form. Ten ml urine sample was obtained after informed consent and subjected to a quantitative cotinine estimation by direct enzyme-linked immunosorbent assay. Results: A total of 100 patients were screened, of which 79 were finally included. The self-report or recent tobacco use showed only a moderate concordance with urinary cotinine (k=0.518) and cotinine-creatinine ratio (k=0.492). Over 15% patients had denied the use of tobacco, but tested positive on urinary cotinine assessment. The sensitivity of self-report was 73.3% compared to urinary cotinine. The denial among users was 26.7% and denial among those with negative self-report was 30.8%. Conclusion: Mental health professionals should be vigilant for detection of tobacco dependence among remitted bipolar patients, who may not be so forthcoming about their tobacco use.