Susham Gupta

WPA guidance on mental health and mental health care in migrants

The purpose of this guidance is to review currently available evidence on mental health problems in migrants and to present advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the process of migration and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed. The epidemiology of mental disorders in migrants is described. A series of recommendations to policy makers, service providers and clinicians aimed to improve mental health care in migrants are provided, covering the special needs of migrants concerning pharmacotherapies and psychotherapies.

Alcohol-related dementia: a 21st-century silent epidemic?

Evidence suggests a J-shaped relationship between alcohol consumption and cognitive impairment and other health indicators, with low levels of consumption having better outcomes than abstention or moderate to heavy drinking. Most research to date has focused on the protective effects of drinking small amounts of alcohol. As alcohol consumption is escalating rapidly in many countries, the current cohort of young and middle-aged people may face an upsurge of alcohol-related dementia. The dangers of heavy drinking and its effect on cognition require further attention.

Clinical decision making in psychiatry by psychiatrists

Bhugra D, Easter A, Mallaris Y, Gupta S. Clinical decision making in psychiatry by psychiatrists.

Use of community treatment orders in an inner-London assertive outreach service

Aims and method To compare admission rates and bed occupancy before and after the introduction of community treatment orders (CTOs) in 37 assertive outreach service patients. The effect of CTOs on treatment adherence and illicit drug use were also evaluated. The views of patients and care coordinators were obtained through a focus group. Results When CTOs were introduced, admission rates fell from 3.3 to 0.3 per year and average bed occupancy declined from 133.2 to 10.8 days per year. Treatment adherence improved from 4 (10.8%) to 31 (83.7%) patients, and an objective reduction in substance misuse was observed in 25 (67.5%) patients. Whereas patients expressed ambivalence towards CTOs, their care coordinators generally had a more positive view. Clinical implications The decline in hospital usage following the introduction of CTOs is encouraging and could reflect improved adherence and engagement through intensive case management, leading to a reduction in readmissions. However, further studies need to look at quality of life, cost-effectiveness and the impact on patients.

Efficacy of Maintenance Electroconvulsive Therapy in Recurrent Depression : A Naturalistic Study

Background and Objective: The use of maintenance electroconvulsive therapy (mECT) in contemporary psychiatric practice is controversial. In the United Kingdom, the National Institute for Health and Clinical Excellence has recommended that mECT should not be used, although evidence underpinning this decision is lacking. Undertaking a randomized evaluation of this treatment would now be very difficult in the United Kingdom. The main aim of this study is to evaluate the efficacy of mECT in reducing recurrence in depression. Method: A retrospective analysis of 19 patients who had responded positively to an index and continuation course of ECT and then proceeded to receive mECT. We compared the number of hospital admissions and duration of hospital stay over 3 time periods: 2 years before ECT, during mECT, and up to 4 years after cessation of mECT. To account for secular trends in service use, we also compared the admission rates of this group with a matched sample who received successful index ECT followed by other maintenance therapies (comparison group). Results: Participants received an average of 37 applications of mECT over a median period of 26 months. Inpatient hospital stay and rate of admissions to an acute psychiatric unit fell significantly during the period of mECT compared with the rates before the initiation of mECT. This reduction in bed use was maintained after termination of mECT. No reduction of service use was observed in the comparison group. Conclusions: The findings suggest that mECT may have a role in reducing the rate and duration of hospital stay of patients with major depressive disorder.

Sexual variation in India: A view from the west.

Sexual variation has been reported across cultures for millennia. Sexual variation deals with those facets of sexual behavior which are not necessarily pathological. It is any given culture that defines what is abnormal and what is deviant. In scriptures, literature and poetry in India same sex love has been described and explained in a number of ways. In this paper we highlight homosexual behavior and the role of hijras in the Indian society, among other variations. These are not mental illnesses and these individuals are not mentally ill. Hence the role of psychiatry and psychiatrists has to be re-evaluated. Attitudes of the society and the individual clinicians may stigmatize these individuals and their behavior patterns. Indian psychiatry in recent times has made some progress in this field in challenging attitudes, but more needs to be done in the 21st century. We review the evidence and the existing literature.

Why do we need a social psychiatry

Human beings are social animals, and familial or social relationships can cause a variety of difficulties as well as providing support in our social functioning. The traditional way of looking at mental illness has focused on abnormal thoughts, actions and behaviours in response to internal causes (such as biological factors) as well as external ones such as social determinants and social stressors. We contend that psychiatry is social. Mental illness and interventions in psychiatry should be considered in the framework of social context where patients live and factors they face on a daily basis.

Migration and Mental Health: Cultural bereavement, culture shock and culture conflict: adjustments and reactions

This chapter argues that the processes of globalization influence market, political and social forces. It suggests that various manifestations of globalisation include rapid communication, cheap modes of travel, increasing deregulation in economic matters and international political organisations. Economic factors add to the likelihood of developing psychiatric disorders and these are likely to be caused by industrialisation and urbanization. Studies over the past century have repeatedly identified migration as an important factor in the development of mental disorders in migrant communities. Rex draws a distinction between colonial societies and advanced metropolitan industrial societies which have lesser coercive sanctions. Colonial societies rely on these coercive sanctions and also have higher levels of racism and racialism. Another interesting and useful notion of the rise of the therapeutic culture of the self linked with more general political transformation has been described by Rose.

Through the prism darkly: how do others see psychiatrists?

Objective: With changes in healthcare delivery and public expectations of psychiatry and psychiatric services changing, we set out to explore how other professions and psychiatrists themselves see their roles. In the UK and the USA, recent political imperatives have influenced training and roles of psychiatrists. We wanted to explore patient and carer perspectives as well. Methods: We conducted two focus groups with patients and carers to explore their views about the roles of the psychiatrist. For occupational therapists and social workers, a brief questionnaire was placed on their respective professional organizations website. Psychiatric trainees and psychiatrists attending different meetings were asked to fill in the questionnaire. Results: Patients and carers wanted to be more involved in planning their care. In common with other groups, being technically competent, being honest, approachable and being a good listener were general characteristics of a good psychiatrist. Occupational therapists saw psychiatrists as having a unique expertise and ability to provide leadership and also having skills in teaching, research, evaluating evidence and being respectful of other professions. Social workers would like psychiatrists to look beyond the medical model. Conclusions: In spite of different methods of collecting information, common themes emerge in what stakeholders expect from psychiatrists. As a profession, we need to respond to this.

Globalization, Economic Factors and Prevalence of Psychiatric Disorders

With the process of globalization in full flow, the movement of people and products across the globe has brought a series of difficulties. With migration, the socioeconomic status of the individuals may change, with the likelihood that this status will be lower rather than higher—although, depending on the reasons for migration, this may change too. The literature shows that low socioeconomic status is associated with a higher level of psychiatric morbidity. Whether migration acts as a mediator needs further investigation. Various studies have shown that rates of psychosis are elevated in migrants although these rates are differentially increased in different groups, indicating that factors other than migration may be at play. We review the literature and link the acculturation and cultural identity with postmigration experiences.