Shachi Mathur

Management of attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD/ADD) is a neurobehavioral disorder of childhood onset characterized by severe, developmentally inappropriate motor hyperactivity, inattention, and impulsiveness that result in impairment in more than one setting. It affects the home, school, and community life of 39% of school-going children worldwide. There is increasing recognition that ADHD symptoms and clinically defined disorder can persist into adult life and are associated with later drug and alcohol misuse and social and work difficulties. Added to that is the extreme variability of the disorder over time, within the same individual, between individuals, and across different circumstances. Treatment with stimulants and nonstimulants has proven effective in different subgroups, with the effectiveness of specific agents most likely related to the primary neurotransmitter involved. However, stimulants with a short duration of action have been problematic for some patients. Parent training and cognitive behavioral therapies represent the most widely adjunct psychosocial interventions to pharmacotherapy.

A study of predictors of anxiety and depression among stroke patient-caregivers

Context: Caregivers play an important role in supporting people with illness either acute or chronic. It is important to explore caregivers emotional turmoil as it helps in exploring their burden which can have impact on the patients illness and functioning apart from their own. Aims: The current study aimed at assessing the predictors of anxiety and depression among caregivers of patients with stroke. Settings and Design: Seventy-five consecutive patient-caregiver dyads were recruited in the study. Materials and Methods: Patients and caregivers were assessed using a semi-structured proforma for the sociodemographic details. Subsequently these dyads were assessed for anxiety and depression levels using the Hospital Anxiety and Depression Scale. Statistical Analysis Used: Chi-square tests (for categorical variables) were used to find difference between the patients and the caregivers on different variables. Additionally Cramers V-test and phi test were used for 2*4 contingency tables. Linear regression model was used. Results: Linear regression revealed that anxiety level in caregivers was predicted by the sex of care giver. Conclusions: Caring for the patients with stroke presents increased burden to the care givers which manifests as increased rate of anxiety and depression among them. It is important to assess the care givers along with the patients for emergence of these negative affective states. One needs to be extra cautious if the patient happens to be the primary earning member of the family.

ECT prohibition for children and adolescents in Mental Health Care Act of India: a step in the right direction???

T he Mental Health Act of India 1987 is being revised. The proposed draft of the newMental Health Care Act of India 2010 is currently being debated on.1 There are many welcome changes and additions to the draft of the new act. It has been designed to be in accordance with the United Nations Convention on Rights of Persons with Disability. The preamble of the act identifies the persons with mental illness as a vulnerable section of society. The act is aimed at ensuring that persons with mental illness are provided health care, treatment, and rehabilitation in the least restrictive environment possible and in a manner that does not intrude on their rights and dignity. However, this new act has put electroconvulsive therapy (ECT) for minors under Section 51. This section describes the treatments prohibited by the act. Beyond this, the draft does not specify any reason for such a recommendation. The earlier Act of 1987 did not have any such provision. The provision of prohibition of ECT for minors seems to stem from the recommendation made in the World Health Organization Resource Book on Mental Health, Human Rights, and Legislation. The document recommends that ‘‘there are no indications for the use of ECT on minors, and hence this should be prohibited through legislation.’’ Electroconvulsive therapy has been in continuous use for more than seven decades. No treatment modality for psychiatric disorders has stood the test of time for so long. It has an extensive evidence base supporting its effectiveness and safety among adults for various psychiatric disorders, such as major depression, bipolar affective disorder, psychotic disorders (including schizophrenia), catatonia, acute suicidality, and neuroleptic malignant syndrome. The history of the use of ECT for children and adolescents also dates back to the fourth decade of the last century. The efficacy of pediatric ECT for affective disorders, psychotic disorders, and catatonia has been described in various case reports. Overall efficacy rates of 63% for depression, 80% for mania, 42% for schizophrenia, and 80% for catatonia has been described for ECT among children and adolescents in a review. There is evidence supporting the use of ECT in adolescents for the same indications as adults, with reports of equal clinical efficacy. The American Academy of Child and Adolescent Psychiatry has also endorsed the use of ECT in its guidelines. The ECT has been found to be a safe therapeutic procedure with a mortality rate of up to 4 deaths per 100,000 treatments. Most of this mortality is attributed to severe cardiac diseases among the elderly. Hence, it is likely safer for children and adolescents who have a healthier cardiac profile. There is no credible evidence supporting an adverse impact of ECT on the developing brain. Prospective studies on the use of ECT among children and adolescents have failed to find any significantly increased risk of acute cognitive damage, cognitive impairment after 3 to 5 years of follow-up,22 and a decline in social functioning or school achievement23 as compared with controls. In fact, ECT might have neuroprotective and neurotropic effects. Restrictions on the use of ECT for children and adolescents have been placed by certain states, such as California and Texas in the United States. Concerns have been expressed by underutilization of this evidence based on the recommended intervention in clinical practice. Only 0.2% and 0.8% of all ECT recipients were minors in Australia and Turkey, respectively. However, a move to prohibit the use of ECT for this age group was described as unconstitutional and rejected in Italy. The ethical arguments put forth for the use of ECT for children and adolescents have also been answered comprehensively. India has an enormous burden of mental health problems among children and adolescents. Children and adolescents younger than 16 years constitute more than 40% of India’s population. Community-based epidemiological studies in India have reported overall point prevalence rates of EDITORIAL

Alcohol: A Major Public Health Problem—South Asian Perspective

Over the years, use of alcohol, excessive and prolonged, has been associated with various health hazards. With increasing clinical experience and research in the area, the association has become stronger and progressively more alarming. The evidence from different treatment settings viz. the outpatient department, inpatient setup, emergency department, and the consultation liaison services has linked the use of alcohol with a wide array of hazards to the physical and the psychological health of the users. The impact on psychological health extends beyond the users of alcohol to involve caregivers and other family members of users. Alcohol consumption is the leading risk factor for disease burden in low-mortality developing countries and the third largest risk factor in developed countries. Added to this is the fact that a significant proportion of those needing the help of deaddiction service providers and of mental health professionals present to various other departments including medicine, surgery, gastroenterology, nephrology, and cardiology, among others. We present here a comprehensive review of the impact of alcohol use on health. We have reviewed the relevant literature from south Asian countries using Pubmed search. In addition, other information sources such as Cork Bibliography, published monographs, and study reports have been included in the review.

A Comparative Study of Attitudes toward Psychiatry among Nursing Students across Successive Training Years

Context: Psychiatry nurses are an integral component of a multidisciplinary mental health-care team. Aim: The current study aimed at understanding the attitude of undergraduate nursing students toward psychiatry. Additionally, the attitudes toward psychiatry have been compared across the training years among these students. Materials and Methods: The study was carried out at a tertiary care nurse-training institute. All the nursing students enrolled with the institute at the time of the study constituted the sample frame. The study questionnaire used in the current study was a 29-item questionnaire that assessed attitudes toward psychiatry. Statistical Analysis: The data were analyzed using SPSS ver 17. Results: Overall, the majority of the nursing students from all four groups had a favorable response to the statements of the Likert scale. Most of the significantly positive responses (as assessed by the Kruskal-Wallis analysis of variance of the rank order) were from the third-year and internship students. These findings were supported by the significant correlation between these statements and ranked order of the nurse-training years. Conclusions: The findings of the current study present some interesting insights into the attitude of nursing students toward psychiatry.

A Cross-Sectional Study of Body Shape and Eating Attitude among Indian Female Healthcare Students

Objective: The current study aimed at assessing eating attitude and body shape concerns among Indian female healthcare students who had received some teaching/training in Psychiatry. Method: The study was conducted at government medical and nursing college. All the undergraduate healthcare students enrolled with institute at the time of study constituted the sampling frame for the study. Survey-based methodology was used for data collection. Study scales included semi-structured proforma, Eating Attitudes Test-26 (EAT-26) (including the three sub-scales), and Body Shape Questionnaire (BSQ). Data were analyzed using Pearsons and Spearmans correlation statistics and ANOVA with post hoc analysis. Results: A total of 498 students returned the completed study questionnaire. There was significant correlation between Body Mass Index (BMI) and EAT-26 scores) including the sub-scales score of EAT-26). Similarly, BMI and BSQ scores were also significantly correlated. Discussion: The findings from current study help understand the body shape and eating attitudes of Indian female healthcare students who had received some teaching/training in Psychiatry.

A Study of Attitude and Knowledge of the Psychiatry Resident Doctors toward Clinician-Pharmaceutical Industry Interaction

Background: Pharmaceutical industry and clinicians are the two important stakeholders in the modern-day health care. However, concerns have been expressed about the lack of congruence between the goals of these two. Aims: The current study aimed at exploring the knowledge and attitude of the psychiatry resident doctors toward the clinician–pharmaceutical industry interaction and also at exploring the knowledge of the residents about the new Medical Council of India guidelines on this issue. Materials and Methods: The survey was conducted among psychiatry residents. Descriptive statistics with frequency distribution was carried out by using SPSS version 17.0. Results: It had a good response rate of around 90%. The survey reveals the knowledge and attitude of the psychiatry residents toward the psychiatrist–pharmaceutical industry interaction. Conclusions: The survey provides understanding in knowledge and attitude of the psychiatry residents towards the psychiatrist-pharmaceutical industry interaction.