Service utilization in a tertiary psychiatric care setting in South India

The relationship between cognitive functioning, age and employment in people with severe mental illnesses in an urban area in India: A longitudinal study

Although there is substantial evidence of the association between cognitive impairment and work in people with severe mental illnesses (SMI) in developed countries, less is known about this relationship in developing countries such as India. Studies showing higher rates of employment in people with SMI in developing countries than developed ones raise the question of whether cognitive functioning is related to work status and characteristics of work (e.g., wages earned). We conducted a one-year follow-up study to investigate the relationship between employment and cognitive functioning, assessed with the Montreal Cognitive Assessment (MoCA), in 150 participants with SMI (92% schizophrenia) living in an urban area and receiving psychiatric outpatient treatment at a public hospital in India. The MoCA had good internal reliability and test-retest reliability over the one-year period. Better cognitive functioning was associated with younger age, shorter duration of illness, higher education, and male gender. Both younger and older participants with higher cognitive functioning at baseline were more likely to be employed at baseline and one year later. Work status at baseline and one year follow-up was consistently related to executive functions among younger participants, and to attention among older participants, suggesting changes over the course of illness in the importance of specific cognitive domains for achieving satisfactory work performance. The findings suggest that cognitive functioning is associated with employment in people with SMI in India. Attention to impaired cognitive functioning may be critical to improving employment outcomes in this population.

Treatment non-adherence pattern among persons with neuropsychiatric disorders: A study from a rural community mental health centre in India

BACKGROUND

Treatment gap causes significant loss to individuals, families, societies and the nation. Treatment adherence enhancement is a major challenge in psychiatric disorders. Globally, the community mental health services are obligated to minimize the treatment and adherence gap. In recent years' retrospective studies are gaining importance to measure the trend of mental health service utilization, cost effectiveness, resources allocation and similar aspects.

AIM

To explore the treatment adherence pattern of persons with neuropsychiatric illness from a rural community mental health centre.

METHOD

Five hundred and ninety-six medical records of persons with neuropsychiatric disorders who registered for outpatient treatment between 2015 and 2017 at Sakalawara Rural mental health centre of National Institute of Mental Health and Neuro Sciences, Bangalore, India, were reviewed to understand their adherence pattern.

RESULTS

Out of 596 patients, 68 (11.4%) were referred to tertiary care mental health and District Mental Health Programme (DMHP) services. Out of the remaining 528 patients, 29.7% were regular to mental health services over a period of 12 months and above; majority of the patients (36.2%) dropped out of their treatment after their first contact and 34.1% discontinued their follow up visits over a period of first week to 12 months.

CONCLUSION

Community based mental health centres too face challenges of and problems related to treatment non-adherence. Persons with neuropsychiatric disorders require continuity of care through regular home visits, out-reach services and innovative methods which will enhance treatment adherence.

Challenges in tracing treatment non-adherent persons with mental illness: Experiences from a rural community mental health center, India

Identification, enrollment, and retention in treatment are challenging processes in mental health care. The present paper highlights the challenges in tracing and reenrolling non-adherent persons with mental illness for treatment in a rural community mental health center. Unclear address, phone numbers not in use, relocation from the given address, no further contact details etc. are the barriers to trace and make the home visits. A detailed review of the medical record, having a network with the village informal health care workers and groups, utilizing peer group support, etc., are the facilitators for tracing the treatment non-adherent persons in the community.

Profile of Women Seeking Treatment for Substance Use Disorder in Tertiary Care Government De-Addiction Centre

Background

There is an increasing trend among women using substance. However, very few women seek treatment for substance use disorder in Government de-addiction centre. There is limited literature available regarding the same.

Aim

To examine the profile of women seeking treatment for substance use disorder in Government De-addiction Centre, Bengaluru.

Methods

The study was retrospective in nature. All the female patients who sought in-patient treatment from centre for addiction medicine, NIMHANS, Bengaluru from Apr 2015- Sept 2016 were included in the study. Method of data collection: Content analysis was used to collect the secondary data from the hospital record. Descriptive statistics such as mean, frequency distribution was used for statistical analysis.

Results

Mean age of women who sought treatment for substance use disorder in the centre was 42 ±14 years. The mean age at initiation of alcohol was 27 ±9 years, alcohol dependence was 34 ±10.6 years. Majority (65%) belonged below poverty line. 59% were married and living with their spouse. 55% of them sought treatment either on their own or brought by family members, 38% referred by the psychiatrist. More than one-third (36%) had primary school education. Nearly one-third (27%) of them had repeated admissions more than once. More than one-third of them (34%) were homemakers, nearly one-fourth (24%) of them were lost their previous job, 6% of them students and professionals respectively.

Conclusion

The majority (68%) of women had diagnosis of alcohol dependence, nicotine (44%), benzodiazepine (14%), opioid dependence (11%), cannabis dependence (1.6%), less than 1% had other forms behavioural addictions.

Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: protocol for a cross-sectional study (IMPACT SMI survey)

INTRODUCTION

People with severe mental illness (SMI) die on average 10-20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia.

METHODS AND ANALYSIS

We will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder scale (GAD-7)) and health-related quality of life (EQ-5D-5L). We will measure blood pressure, height, weight and waist circumference according to WHO guidelines. We will also measure glycated haemoglobin, lipid profile, thyroid function, liver function, creatinine and haemoglobin. Prevalence rates of physical health conditions and health-risk behaviours will be presented and compared with the WHO STEPS survey findings in the general population. Regression analyses will explore the association between health-risk behaviours, mental and physical health conditions.

ETHICS AND DISSEMINATION

The study has been approved by the ethics committees of the Department of Health Sciences University of York (UK), Centre for Injury Prevention and Rehabilitation (Bangladesh), Health Ministry Screening Committee and Indian Council of Medical Research (India) and National Bioethics Committee (Pakistan). Findings will be disseminated in peer-reviewed articles, in local and international conferences and as reports for policymakers and stakeholders in the countries involved.

TRIAL REGISTRATION NUMBER

ISRCTN88485933; 3 June 2019.

A study on collaborative telepsychiatric consultations to outpatients of district hospitals of Karnataka, India

INTRODUCTION

The Indian National Mental Health Survey (NMHS) of 2015-2016 has estimated 13.7% lifetime and 10.6% point prevalence for mental illnesses. It has identified that the treatment gap for mental illnesses ranges between 70% and 92%. Tele-Psychiatric consultations could be an alternative and innovative approach to bridge this gap in low resource settings.

AIMS

To study the sociodemographic and clinical profiles of patients who have received collaborative Tele-Psychiatric consultations across district hospitals in Karnataka, India.

METHODOLOGY

We performed a retrospective review of case files of patients who have received collaborative Tele-Psychiatric consultations from January 2013 to June 2017 through video-conferencing. A total of 139 consultations were provided to patients in the state of Karnataka.

RESULTS

The mean age of the sample is 31 (±15.5) years. 61.8% were male and 79.8% were aged more than 18 years. In total, 25.9% of them had schizophrenia and other psychotic disorders, 14.4% had mental retardation, 13.7% had a mood disorder and 14.4% had a substance use disorder. 67.6% of patients had been advised pharmacotherapy, 7.9% had been advised rehabilitation along with pharmacotherapy and 24.4% were advised further evaluation of illness and inpatient care at a higher centre.

CONCLUSION

Collaborative tele-psychiatric consultations to district hospitals from an academic tertiary care hospital can be feasible and are likely to benefit patients from rural areas. There is a need for more studies to elucidate their acceptability by patients, caregivers and professionals.

Cannabis induced psychosis and subsequent psychiatric disorders

INTRODUCTION

Long term change in diagnosis of patients having Cannabis induced psychosis (CIP) at the index evaluation is well recognised. Some patients are known to achieve complete remission while others go on to develop independent schizophrenia or mood disorders.

AIMS

To study the long-term course of CIP and factors influencing it.

METHOD

Patients diagnosed as CIP (ICD 10: F12.5), admitted at NIMHANS, a tertiary neuropsychiatry centre at Bangalore, over the past 10 years were identified from medical records. 200 case records were identified and screened in detail. 57 met inclusion criteria and 35 patients could be followed up. Mean follow up duration was 5.75 years.

RESULTS

Patients who completely abstained from cannabis after the 1^st episode had no relapse of psychiatric illness. They showed marked improvement in socio-occupational functioning as well. All those who relapsed to cannabis use had a recurrence of illness. Half the patients with predominantly non-affective psychosis progressed to an independent psychiatric disorder; while only 7.7% patients with predominantly affective psychosis developed an independent disorder (p=0.01). Besides this, early onset of cannabis use (≤18years), younger age at onset of 1st episode, positive family history of psychiatric illness, being unmarried and lower socio-economic status were associated with poor prognosis. Abstinence later in the course of illness did not improve outcome significantly.

CONCLUSION

Abstaining from cannabis early in the course of illness is critical for good recovery. The course of CIP is variable and categorising CIP into affective vs. non-affective psychosis can be useful in clinical practice.

Clinical and Demographic Profile of Attendees at Baghdad's Walk-in Psychiatric Clinic

OBJECTIVE

Few studies have examined clinical and demographic profile of attendees of a walk-in psychiatric clinic in countries ravaged by wars. The aim of this study is to quantify the characteristics of attendees of an open walk-in psychiatric clinic in a general hospital in Baghdad and the suburb towns of Iraq in the year 2010.

METHODS

As part of a retrospective survey, information on specific variables (socio-demographic background, clinical characteristics and attendance rate) were sought from medical records in the year 2010 (January to December).

RESULTS

Despite the shortcomings expected from a country coming out of the ravage of war, the survey included 2,979 attendees (1,864 [63%] males and 1,115 [37%] females) of a walk-in psychiatric clinic who fulfilled the inclusion criteria. The profile of attendees indicated that a majority of the cohort was self-referred with a predominance of employed males, aged 19 to 49 years, residing in Baghdad City. Depression and psychosis were the most common diagnosis given.

CONCLUSION

The observed patterns are discussed within the available literature relevant to consultation liaison psychiatry, and specific to situations in Iraq and Arab/Islamic cultural patterning.