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Grover S, Kathiravan S. Acute and transient psychotic disorders: A review of Indian research. Indian J Psychiatry 2023; 65:895-913. [PMID: 37841545 PMCID: PMC10569331 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_254_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/26/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023] Open
Abstract
Background Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. Aim This paper aims to review the literature on ATPD emerging from India. Methodology A combination of search terms "Acute and Transient Psychosis," "acute psychosis," "non-affective psychosis," "non-affective psychotic disorder," "reactive psychosis," "first-episode psychosis," and "India" were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. Results The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. Conclusion There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Clinical care of patients with dual disorders in India: diverse models of care delivery. ADVANCES IN DUAL DIAGNOSIS 2022. [DOI: 10.1108/add-09-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose
This study aims to offer an overview of the models of clinical care of the patients with dual disorders in India.
Design/methodology/approach
All the members of the Dual Diagnosis India Network (DDIN) who shared the clinical care delivery at their center were invited to share the details of their model. In addition, an invite was also sent to those members who could not attend the online session but were interested in contributing the required information about their model. The information shared by the respondents was collated. The different models were then categorized based on their features.
Findings
Following the categorization of the clinical care services organization across different settings, five different models emerged. These were specialized dual diagnosis clinic; services for dual disorders offered as substance use disorder (SUD) treatment services within general psychiatry care; services for dual disorders in general psychiatry care; services for dual disorders offered as SUD treatment services separated from general psychiatry care; and services for dual disorders offered in general psychiatry services combined with exclusive SUD treatment services.
Originality/value
Currently, there is limited literature on models of dual disorders from the low- and middle-income countries. The authors believe that the documentation of these models from India shall be of help while setting up services for dual disorders in other health-care settings. This study can be a valuable resource for making informed choices while setting up new services.
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Malla A, Iyer SN, Rangaswamy T, Ramachandran P, Mohan G, Taksal A, Margolese HC, Schmitz N, Joober R. Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India. Br J Psychiatry 2020; 217:514-520. [PMID: 32624012 DOI: 10.1192/bjp.2020.126] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS). AIMS To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences. METHOD Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted. RESULTS Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = -7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes. CONCLUSIONS Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal; and Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada
| | | | | | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | | | - Ridha Joober
- Department of Psychiatry, McGill University, Canada
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Muruganandam P, Neelamegam S, Menon V, Alexander J, Chaturvedi SK. COVID-19 and Severe Mental Illness: Impact on patients and its relation with their awareness about COVID-19. Psychiatry Res 2020; 291:113265. [PMID: 32763536 PMCID: PMC7322460 DOI: 10.1016/j.psychres.2020.113265] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 02/08/2023]
Abstract
COVID-19 outbreak has promoted many public health measures in the general population. However, its impact on a vulnerable population with severe mental illness (SMI) is less addressed. Aim of this study was to determine the impact of COVID -19 to patients with SMI and identify its relation with their COVID-19 knowledge. A cross-sectional telephonic survey among 132 patients with SMI who were clinically stable before the COVID-19 pandemic was conducted. A 23 item interview proforma comprising of self-reported knowledge related to COVID-19 by patients and their illness and treatment status from their caregivers. Eleven patients were completely not aware of the ongoing COVID-19 pandemic. Three fourth of patients were not worried about getting COVID-19 and lacks adequate knowledge to identify symptoms. Two-third of patients lacked adequate knowledge of precautionary measures against COVID-19. One out of five patients lacked knowledge of the mode of transmission and stopped their psychiatric treatment. Thirty percent showed features of relapse of symptoms during this lockdown period. In multivariate regression analysis, patients from lower socioeconomic status, low literacy levels, with inadequate social support showed less knowledge related to COVID-19. Mental health services which target this vulnerable population during early disaster reduce the burden to the community.
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Affiliation(s)
- Partheeban Muruganandam
- Department of Psychiatry, Aaarupadai Veedu Medical College & Hospital, Puducherry-607402, India.
| | - Srinivasan Neelamegam
- Department of Psychiatry, Aaarupadai Veedu Medical College & Hospital, Puducherry-607402, India
| | - Vikas Menon
- Department Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry-605006, India
| | - Johndinesh Alexander
- Department of Psychiatry, Aaarupadai Veedu Medical College & Hospital, Puducherry-607402, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore-560029, India
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Singh S, Balhara YPS. A review of Indian research on co-occurring cannabis use disorders& psychiatric disorders. Indian J Med Res 2018; 146:186-195. [PMID: 29265019 PMCID: PMC5761028 DOI: 10.4103/ijmr.ijmr_791_15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND & OBJECTIVES Cannabis is a widely used illicit drug and its use is often associated with co-occurring psychiatric disorders. This systematic review was aimed to provide information on the published Indian studies on co-occurring cannabis use disorders and psychiatric disorders. METHODS An electronic search of available Indian literature using relevant search terms was carried out in May 2015 and 52 articles in English language published from India were included in the current review. RESULTS Studies on cannabis and associated psychotic disorders (n=16) chiefly described acute episodes with predominant positive symptoms, following cannabis use. Some studies (n=6) observed an overall increased prevalence of all psychiatric disorders and symptoms owing to cannabis use, while others (n=14) elaborated on high rates of substance use in those with psychiatric disorders. The effect of cannabis use on cognitive function was the focus of some of the Indian studies (n=7). All these studies barring one had all male subjects, and a single study described the service delivery model for those with dual diagnosis disorders in India. Most of the research used cross-sectional observational design and focussed on treatment-seeking population. INTERPRETATION & CONCLUSIONS A review of Indian literature on cannabis use and its association with psychiatric disorders indicates a high co-prevalence of psychotic disorders, especially in vulnerable individuals as well as high rates of co-occurrence of other psychiatric comorbidities. However, there is limited focus on exploring the aetiological association between cannabis use and psychiatric disorders; understanding the neurobiology of this association and management-related issues.
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Affiliation(s)
- Shalini Singh
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry; National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Banyal N, Bhattacharyya D, Yadav P. Study to determine the prevalance of substance use and factors associated with it, in first-episode of psychosis. Ind Psychiatry J 2018; 27:264-270. [PMID: 31359982 PMCID: PMC6592209 DOI: 10.4103/ipj.ipj_86_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Psychoactive substance use occurs commonly in patients with psychotic disorders. AIM This study aimed to determine the prevalence of substance use in first-episode psychotic patients and to evaluate the association between substance use and various sociodemographic variables. MATERIALS AND METHODS This was a cross-sectional study, and symptomatic first-episode, treatment-naive psychosis patients were included (n = 79). A semi-structured pro forma was used for the evaluation of sociodemographic and clinical characteristics. The patients were then interviewed for use of any psychoactive substance in their lifetime. In each case, the history was corroborated by a family member or a caregiver. Wherever required, a second interview was conducted. RESULTS The mean age at the onset of psychotic disorder for substance users was 36.09 years and for nonusers was 35.50 years. Almost three-fourth of the patients reported the use of at least one substance in their lifetime. Alcohol use was reported by 40.50% of patients, tobacco by 55%, and cannabis by 8.86%. It was significant in patients who were diagnosed with schizophrenia, acute and transient psychotic disorder, persistent delusional disorder, and unspecified nonorganic psychotic disorder. CONCLUSION The results show a high prevalence of psychoactive substance abuse compared to the prevalence in the general population. This has tremendous significance in the management of such illness, which is known to impact the prognosis adversely.
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Affiliation(s)
- Navdeep Banyal
- Department of Psychiatry, 166 MH, Jammu, Jammu and Kashmir, India
| | | | - Prateek Yadav
- Department of Psychiatry 151 Base Hospital, Guwahati, Assam, India
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Abstract
A large proportion of patients with substance use disorders have clinical comorbidities, either medical or psychiatric. An initial assessment is necessary initially for prompt identification and management of any psychiatric or medical emergency, and thereafter a more detailed assessment for the comprehensive understanding of the individual. This should be done keeping in mind the goals of both immediate and long term assessment so that a comprehensive but individualized, context and culture sensitive, reality based, recovery-oriented management plan can be formulated. Assessment should consist of not only history-taking, physical and mental status examination but also laboratory and instrument based assessment as needed. During assessment, collateral reports and past medical records are valuable additions along with self-report. Since substance use disorders influence various aspects of daily life, hence medical, social, occupational, religious, spiritual, financial and legal aspects should be evaluated. Overall, the assessment needs to be diagnosis and management focused, covering the various bio-psycho-social domains relevant to the individual.
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Affiliation(s)
- Debasish Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Abhishek Ghosh
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Das P, Sreedaran P, Mv A. A study to compare the differences between genders in psychiatric comorbidities in individuals with psychoses. Asian J Psychiatr 2018; 32:84-88. [PMID: 29220783 DOI: 10.1016/j.ajp.2017.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/24/2017] [Accepted: 11/27/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychiatric comorbidities worsen the outcome and increase severity of suffering in psychotic disorders. Gender differences have also been found to impact the severity and outcome in psychoses. In this background, this study attempted to compare psychiatric comorbidity between genders. AIMS AND OBJECTIVES The aim was to compare psychiatric co-morbidity between men and women with psychotic disorders. METHODOLOGY A descriptive cross sectional study design was used. Data was collected through clinical interviews using standardized tools as well as the current case records. We used the MINI neuropsychiatric interview 5.0 to generate an ICD 10 diagnosis for primary psychotic illness and psychiatric comorbidity. PANSS was used to assess severity. Calgary Depression Scale for Schizophrenia, Hamilton Anxiety rating scale, Yale Brown Obsessive Compulsive Scale, Alcohol Use Disorders Identification Test and Fagerstrom Nicotine Tolerance Questionnaire were used to study comorbidity. RESULTS 100 patients were included in the study. 61% of the population had a psychiatric comorbidity. 42% of the men had significantly more multiple psychiatric comorbidities as compared to 7% among women. Men had significantly more substance use than women. Age of onset of psychosis was not found to be different between men and women. CONCLUSION In this study men had more psychiatric comorbidity than women, owing to greater levels of substance use disorders and anxiety disorders. This could be one of the possible reasons for differing outcomes between men and women with psychotic disorders thus indicating need for systematic future researching in psychiatric comorbidities in psychoses.
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Affiliation(s)
- Praveen Das
- Department of Psychiatry, St John's Medical College Hospital,Sarjapura Road, Bangalore, India.
| | - Priya Sreedaran
- Department of Psychiatry, St John's Medical College Hospital,Sarjapura Road, Bangalore, India.
| | - Ashok Mv
- Department of Psychiatry, St John's Medical College Hospital,Sarjapura Road, Bangalore, India.
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Sullivan K, Pantazopoulos H, Liebson E, Woo TUW, Baldessarini RJ, Hedreen J, Berretta S. What can we learn about brain donors? Use of clinical information in human postmortem brain research. HANDBOOK OF CLINICAL NEUROLOGY 2018; 150:181-196. [PMID: 29496141 DOI: 10.1016/b978-0-444-63639-3.00014-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Postmortem studies on the human brain reside at the core of investigations on neurologic and psychiatric disorders. Ground-breaking advances continue to be made on the pathologic basis of many of these disorders, at molecular, cellular, and neural connectivity levels. In parallel, there is increasing emphasis on improving methods to extract relevant demographic and clinical information about brain donors and, importantly, translate it into measures that can reliably and effectively be incorporated in the design and data analysis of postmortem human investigations. Here, we review the main source of information typically available to brain banks and provide examples on how this information can be processed. In particular, we discuss approaches to establish primary and secondary diagnoses, estimate exposure to therapeutic treatment and substance abuse, assess agonal status, and use time of death as a proxy in investigations on circadian rhythms. Although far from exhaustive, these considerations are intended as a contribution to ongoing efforts from tissue banks and investigators aimed at establishing robust, well-validated methods for collecting and standardizing information about brain donors, further strengthening the scientific rigor of human postmortem studies.
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Affiliation(s)
- Kathleen Sullivan
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States
| | - Harry Pantazopoulos
- Traslational Neuroscience Laboratory, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Elizabeth Liebson
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - T-U W Woo
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Laboratory of Cellular Neuropathology, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; International Consortium for Psychotic and Bipolar Disorders Research, McLean Hospital, Belmont, MA, United States
| | - John Hedreen
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States
| | - Sabina Berretta
- Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA, United States; Traslational Neuroscience Laboratory, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Program in Neuroscience, Harvard Medical School, Boston, MA, United States.
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Shah D, Chand P, Bandawar M, Benegal V, Murthy P. Cannabis induced psychosis and subsequent psychiatric disorders. Asian J Psychiatr 2017; 30:180-184. [PMID: 29096386 DOI: 10.1016/j.ajp.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
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 1st 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.
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Affiliation(s)
- Dharav Shah
- Dept. of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Prabhat Chand
- Dept. of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Mrunal Bandawar
- Dept. of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Vivek Benegal
- Dept. of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Pratima Murthy
- Dept. of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore 560029, India.
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Castagnini AC, Fusar-Poli P. Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder. Eur Psychiatry 2017; 45:104-113. [PMID: 28756108 DOI: 10.1016/j.eurpsy.2017.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Short-lived psychotic disorders are currently classified under "acute and transient psychotic disorders" (ATPDs) in ICD-10, and "brief psychotic disorder" (BPD) in DSM-5. This study's aim is to review the literature and address the validity of ATPDs and BPD. METHOD Papers published between January 1993 and December 2016 were identified through searches in Web of Science. Reference lists in the located papers provided further sources. RESULTS A total of 295 articles were found and 100 were included in the review. There were only a few studies about the epidemiology, vulnerability factors, neurobiological correlates and treatment of these disorders, particularly little interest seems to exist in BPD. The available evidence suggests that short-lived psychotic disorders are rare conditions and more often affect women in early to middle adulthood. They also are neither associated with premorbid dysfunctions nor characteristic family predisposition, while there seems to be greater evidence of environmental factors particularly in developing countries and migrant populations. Follow-up studies report a favourable clinical and functional outcome, but case identification has proved difficult owing to high rates of transition mainly either to schizophrenia and related disorders or, to a lesser extent, affective disorders over the short- and longer-terms. CONCLUSIONS Although the lack of neurobiological findings and little predictive power argue against the validity of the above diagnostic categories, it is important that they are kept apart from longer-lasting psychotic disorders both for clinical practice and research. Close overlap between ATPDs and BPD could enhance the understanding of these conditions.
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Affiliation(s)
- A C Castagnini
- School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - P Fusar-Poli
- King's College London, Institute of Psychiatry, and OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
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Subodh BN, Hazari N, Elwadhi D, Basu D. Prevalence of dual diagnosis among clinic attending patients in a de-addiction centre of a tertiary care hospital. Asian J Psychiatr 2017; 25:169-174. [PMID: 28262143 DOI: 10.1016/j.ajp.2016.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 10/26/2016] [Accepted: 10/29/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND & AIMS Indian research on dual diagnosis is mostly on prevalence of co-morbidity in a particular type of substance use disorder or psychiatric disorder. They were not on overall prevalence of dual diagnosis in a clinical sample. The study aims to assess prevalence of dual diagnosis among first time visitors to a tertiary care deaddiction centre. METHODOLOGY The study participants were recruited using computer-generated random number table from 10th Apr 2013 to 28 June 2013 from a deaddiction centre in North India. Psychiatric diagnosis was done by qualified psychiatrist and confirmed by Mini International Neuropsychiatric Interview (M.I.N.I.). RESULTS One seventy nine participants were recruited during the study period. The prevalence of dual diagnosis was 58 (32.4%). Affective disorder group 22 (12.3%) is the most common group followed by anxiety disorders group 20 (11.2%) and psychotic disorder group 9 (5.0%). Duration of use and dependence (in months) of alcohol, opioids, and nicotine was shorter and of cannabis and benzodiazepines was longer in dual diagnosis group compared to non dual diagnosis group. CONCLUSIONS This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The study reported that nearly one third of substance use disorder patients are cases of dual diagnosis. The prevalence reported in our study is lower than reported in some western hospital based and community based studies.
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Affiliation(s)
| | - Nandita Hazari
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Deeksha Elwadhi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Debasish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Chandra RM, Arora L, Mehta UM, Asnaani A, Radhakrishnan R. Asian Indians in America: The influence of values and culture on mental health. Asian J Psychiatr 2016; 22:202-9. [PMID: 26442987 DOI: 10.1016/j.ajp.2015.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 11/30/2022]
Abstract
Asian Indians represent a significant portion of the largest growing race of Asians in the past decade in the United States. This selective review examines major cultural themes related to first- and second-generation Asian Indians living in the United States as they impact psychological and psychiatric dysfunction in this population. Specifically, we review the impact of Asian Indian culture on mental health, discuss the impact of acculturation and ethnic identity development on the mental health of Indian-Americans, and focus on typical mental health problems of Asian Indian adolescents, women and elderly in America. Finally, we provide a brief overview of empirically-supported treatment approaches and cultural considerations for additional treatments relevant to this population. This review is intended to provide an important foundation for more systematic empirically-driven investigation into better understanding how Asian Indian cultural themes impact mental health for Indian-Americans, and how to develop effective treatments for these issues in this cultural group.
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Affiliation(s)
| | - Lily Arora
- Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Urvakhsh M Mehta
- Beth Israel Deaconess Medical Center, Boston, MA, United States; National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Anu Asnaani
- Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, 3535 Market St, Suite 600 North, Philadelphia, PA 19104, United States.
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Symptom Profile of Substance-induced Psychosis Versus Primary Psychosis in a Sample of Egyptian Patients: A Preliminary Study. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lo TL, Warden M, He Y, Si T, Kalyanasundaram S, Thirunavukarasu M, Amir N, Hatim A, Bautista T, Lee C, Emsley R, Olivares J, Yang YK, Kongsakon R, Castle D. Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region. Asia Pac Psychiatry 2016; 8:154-71. [PMID: 27062665 PMCID: PMC4834614 DOI: 10.1111/appy.12234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.
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Affiliation(s)
| | - Matthew Warden
- Hobart and Southern CMHTTasmanian Health Organisation – SouthTasmaniaAustralia
| | - Yanling He
- Department of Epidemiology Shanghai Mental Health CenterShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Tianmei Si
- Department of PsychopharmacologyPeking University Institute of Mental HealthPekingChina
| | | | | | - Nurmiati Amir
- Department of Psychiatry National General HospitalCiptomangunkusumo/Faculty of MedicineUniversity of IndonesiaJakartaIndonesia
| | - Ahmad Hatim
- Department of Psychological MedicineUniversity of MalayaKuala LumpurMalaya
| | - Tomas Bautista
- College of Medicine Philippine General HospitalUniversity of the PhilippinesManilaPhilippines
| | - Cheng Lee
- Department of Community PsychiatryInstitute of Mental HealthSingapore
| | - Robin Emsley
- Department of PsychiatryUniversity of StellenboschStellenboschSouth Africa
| | - Jose Olivares
- Department of PsychiatryComplejo Hospitalario Universitario de VigoVigoSpain
| | - Yen Kuang Yang
- Department of PsychiatryNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan CityTaiwan
| | | | - David Castle
- Department of PsychiatrySt. Vincent's HospitalThe University of MelbourneMelbourneAustralia
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16
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Singh S, Balhara YPS. A Review of Indian Research on Co-occurring Psychiatric Disorders and Alcohol use Disorders. Indian J Psychol Med 2016; 38:10-9. [PMID: 27011396 PMCID: PMC4782438 DOI: 10.4103/0253-7176.175089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Excessive use of alcohol has been identified as a major contributor to the global burden of disease. Excessive use of alcohol is a component cause of more than 200 disease and injury conditions. Alcohol use has been associated with increased morbidity and mortality across all regions of the world including South-East Asia. Epidemiological as well as clinic-based studies from Western countries have reported a high prevalence of co-occurrence of alcohol use disorder and psychiatric disorders. The research has established the clinical relevance of this comorbidity as it is often associated with poor treatment outcome, severe illness course, and high service utilization. Understandably, dual disorders in from of alcohol use disorders and psychiatric disorders present diagnostic and management challenge. The current article is aimed to review systematically the published Indian literature on comorbid alcohol use disorders and psychiatric disorders.
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Affiliation(s)
- Shalini Singh
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, WHO Collaborating Centre on Substance Abuse, All India Institute of Medical Sciences, New Delhi, India; Regional Mentor International Programme in Addiction Studies, Master of Science in Addiction Studies, King's College London, UK; University of Adelaide, Australia; Virginia Commonwealth University, USA
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17
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Berretta S, Heckers S, Benes FM. Searching human brain for mechanisms of psychiatric disorders. Implications for studies on schizophrenia. Schizophr Res 2015; 167:91-7. [PMID: 25458567 PMCID: PMC4427537 DOI: 10.1016/j.schres.2014.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 12/14/2022]
Abstract
In the past 25years, research on the human brain has been providing a clear path toward understanding the pathophysiology of psychiatric illnesses. The successes that have been accrued are matched by significant difficulties identifying and controlling a large number of potential confounding variables. By systematically and effectively accounting for unwanted variance in data from imaging and postmortem human brain studies, meaningful and reliable information regarding the pathophysiology of human brain disorders can be obtained. This perspective paper focuses on postmortem investigations to discuss some of the most challenging sources of variance, including diagnosis, comorbidity, substance abuse and pharmacological treatment, which confound investigations of the human brain.
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Affiliation(s)
- Sabina Berretta
- Translational Neuroscience Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Program in Neuroscience, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University. 161 21st Ave S. #T1217 Nashville, TN, USA
| | - Francine M. Benes
- Dept. of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Program in Neuroscience, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Program in Structural and Molecular Neuroscience, 115 Mill St. Belmont MA, 02478, USA
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18
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Kumar CN, Thirthalli J, Suresha KK, Arunachala U, Gangadhar BN. Alcohol use disorders in patients with schizophrenia: comparative study with general population controls. Addict Behav 2015; 45:22-5. [PMID: 25634440 DOI: 10.1016/j.addbeh.2015.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/28/2014] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the prevalence of Alcohol Use Disorders (AUD) among schizophrenia patients with that of the general population in a south Indian rural community. METHODS Alcohol use pattern of 254 schizophrenia patients in the past year was compared with randomly selected healthy comparison subjects (n=350) from the same community in an administrative block of rural India using the Alcohol Use Disorders Identification Test (AUDIT). RESULTS A significantly smaller proportion of patients used alcohol in the past year (10.2%; 95% CI: 6.5%-14.0%) than controls (18.3%; 95% CI: 15.8%-24.1%; OR=2.2; 95% CI=1.4-3.5). This was true for AUD (hazardous use and harmful use; total AUDIT score >8) also: 5.5% patients (95% CI: 2.7%-8.3%) and 10.3% controls (95% CI: 7.1%-13.4%) had hazardous use (OR=2.0; 95% CI=1.0-3.7). Hazardous use was associated with domicile in villages and lesser years of education. On logistic regression, after controlling for these confounds, the odds of having AUD were 2.7 times more for controls than for patients (95% CI=1.4-5.2). CONCLUSIONS Prevalence of AUD is significantly lower in patients than in the general population in this community. Cross-cultural studies are needed to elucidate factors that underlie contrasting results across different countries.
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Affiliation(s)
| | | | | | - Udupi Arunachala
- Consultant Psychiatrist, Manasa Nursing Home, Thirthahalli, India
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19
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Holla B, Thirthalli J. Course and outcome of schizophrenia in asian countries: review of research in the past three decades. Asian J Psychiatr 2015; 14:3-12. [PMID: 25687233 DOI: 10.1016/j.ajp.2015.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/05/2015] [Accepted: 01/18/2015] [Indexed: 12/01/2022]
Abstract
Considerable variation has been observed in the course and outcome of schizophrenia. With regard to epidemiology of schizophrenia, papers from different Asian countries have reported findings which are in contrast with literature from the western countries. In this background we undertook a narrative review of literature regarding course and outcome of schizophrenia in Asian countries. We conducted Medline search for English-language papers on long-term course and outcome of schizophrenia conducted in Asia in the past 3 decades. We also reviewed data pertaining to Asian countries from the World Health Organization's International Study of Schizophrenia (ISoS). In addition to ISoS, we retrieved 14 reports from 9 Asian countries. While ISoS used comparable methodology across the countries, non-ISoS studies differed substantially in their aims, sampling, follow-up rates and assessment tools used for studying the course and outcome. Overall, the percentage of patients who experienced clinical and functional outcome in the Asian countries were largely comparable to those in the western studies. We observed significant variations in the long-term outcome and mortality in schizophrenia even among the Asian countries. In conclusion, there is substantial variation in the long-term course and outcome and mortality across different Asian countries. The reason for this remains unexplored. Cross-national studies exploring biological and cultural explanations for this variation may provide clues, which may have heuristic, translational and public-health significance.
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Affiliation(s)
- Bharath Holla
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore.
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