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Qadir ZS, Kar N, Ball PA, Morrissey H. Antipsychotic Use: Cross-Sectional Opinion Survey of Psychiatrists in India and United Kingdom. PHARMACY 2023; 11:162. [PMID: 37888507 PMCID: PMC10609856 DOI: 10.3390/pharmacy11050162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of this survey of psychiatrists from the UK and India was to compare their opinions on antipsychotic medication choice and their experiences of such medications' effectiveness and tolerability in patients who were newly diagnosed with acute schizophrenia. Following ethical approval, a cross-sectional online survey of psychiatrists from the UK and India was conducted. Ninety-five responses were received from each country. The most selected first-line APDs in both countries were olanzapine (47.5%), risperidone (42.8%) and aripiprazole (25.3%). A total of 60% of psychiatrists from India (60%) and 48% from the UK (48%) selected 'medication efficacy' as the main factor in their choice. Reassessment and consideration to switch most often took place within 4-6 weeks (53.7%) and 3-6 months (11.6%). The major reasons for switching antipsychotic medications were poor clinical efficacy (69%) and lack of tolerability (45%). Nonadherence was the most common reason for relapse (90% of UK psychiatrists and 70% of Indian psychiatrists), followed by illicit drug use (27.6%). The most commonly reported side effects that led to nonadherence were weight gain (10.8%), drowsiness (10.4%), erectile dysfunction and movement disorders (equally 8.7%). It was concluded that olanzapine, risperidone and aripiprazole are the most commonly selected as the initial treatment choice by psychiatrists from India and the UK. They are perceived as widely effective and well tolerated.
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Affiliation(s)
- Zina Sherzad Qadir
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
| | - Nilamadhab Kar
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
- Black Country Healthcare NHS Foundation Trust, Wolverhampton B71 4NH, UK
| | - Patrick Anthony Ball
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
- School of Dentistry & Medical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Hana Morrissey
- Research Institute in Health Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (Z.S.Q.); (N.K.); (P.A.B.)
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Kumar P, Chaudhary R, Bhalla JK, Gupta A. Pattern of Inpatient Consultation-liaison Psychiatry Utility in a Tertiary Care Hospital. Int J Appl Basic Med Res 2023; 13:34-39. [PMID: 37266533 PMCID: PMC10230519 DOI: 10.4103/ijabmr.ijabmr_505_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Background Consultation-liaison psychiatry (C-LP) is an interface between physical and psychological health where the psychiatrists become a part of the medical team for a holistic approach in the treatment of the patient. Aims Our study aimed to see the pattern and utility of C-LP services among inpatient referrals to the department of psychiatry. Settings and Design This observational descriptive study recorded inpatient referrals to the department of psychiatry of a tertiary care hospital for 2 months. Subjects and Methods The Mini-International Neuropsychiatric Interview (M. I. N. I.) was administered for identifying the comorbid psychiatric diagnoses. Results Most of the received inpatient referrals were for male patients (73.7%) in the age group of 30-60 years (58%). Overall, the referral rate was significantly higher from the emergency department and intensive care units (ICU) (50%), followed by specialty (medicine and surgery) wards (20%) and super specialty (cardiology, gastroenterology, and oncology) wards (16%). Altered sensorium and restlessness were the most common reasons for referral (42%), followed by alcohol/drug withdrawal (21.6%), somatic complaints (7.3%), sadness of mood, disturbed sleep, and deliberate self-harm (6% each). Substance use disorders, including alcohol and opioid (32%), delirium (25%), and depression (19%), were among the most common psychiatric diagnoses seen in the referred patients. Conclusions The pattern observed indicates that most inpatient referrals for psychological evaluation are received for altered sensorium from emergency and ICU than wards. The utility of C-LP helps to understand the reciprocal interdependence between the medical illness and the psychiatric comorbidity.
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Affiliation(s)
- Pankaj Kumar
- Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rupesh Chaudhary
- Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Jasleen Kaur Bhalla
- Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aarti Gupta
- Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Gautam S, Gautam M, Jain A, Yadav K. Overview of practice of Consultation-Liaison Psychiatry. Indian J Psychiatry 2022; 64:S201-S210. [PMID: 35602371 PMCID: PMC9122154 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1019_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shiv Gautam
- Department of Psychiatry, Gautam Hospital and Institute of Behavioural Sciences, Jaipur, Rajasthan, India
| | - Manaswi Gautam
- Gautam Hospital and Research Center, Jaipur, Rajasthan, India
| | - Akhilesh Jain
- Department of Psychiatry, ESI Model Hospital, Jaipur, Rajasthan, India E-mail:
| | - Kuldeep Yadav
- Department of Psychiatry, ESI Model Hospital, Jaipur, Rajasthan, India E-mail:
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Grover S, Dua D, Sahoo S, Chakrabarti S. Profile of patients seen in the emergency setting: A retrospective study involving data of 5563 patients. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2021. [DOI: 10.4103/jmhhb.jmhhb_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Munisami T, Namasivayam RK, Annamalai A. Mental-Illness-Related Stigma in Health Care in South India: Mixed-Methods Study. Indian J Psychol Med 2021; 43:58-64. [PMID: 34349308 PMCID: PMC8295582 DOI: 10.1177/0253717620932244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stigma related to mental illness is a reality among health care providers. This study is an attempt to understand the attitudes of doctors from different specialties toward mental illness and the stigma related to it. METHODS We used a concurrent nested mixed-methods approach to understand and identify the various factors of mental-illness-related stigma in medical practitioners. Between November 2018 and March 2019, 100 medical practitioners from South India were administered a self-reporting OMS-HC (Opening Minds Scale for Health Care Providers), followed by in-depth interviews among 25 of the 100 participants selected using purposive sampling. Quantitative surveys were analyzed using SPSSv23. In-depth interviews were transcribed as extended notes, translated, and initially explored using focused coding and the constant comparative method. RESULTS Though findings from quantitative analysis show low to moderate stigma (Mean = 53.52, SD = 7.61), the qualitative study revealed unintended and covert negative attitude toward mental illness. CONCLUSION As stigma occurs at various levels-structural, institutional, interpersonal, and personal-anti-stigma measures also need to be systematically designed. Qualitative studies give more insight regarding the nature of stigma in medical practitioners toward mental illness.
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Affiliation(s)
- Thenral Munisami
- Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kanchipuram, Tamil Nadu, India
| | - Rajesh Kannan Namasivayam
- Government Institute of Psychiatric Medicine, Research and Rehabilitation, Government Theni Medical College & Hospital, Theni, Tamil Nadu, India
| | - Arunkumar Annamalai
- LAMED, Center for Interdisciplinary Research on Language Acquisition and Allied Sciences, Chennai, Tamil Nadu, India
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Grover S, Sahoo S, Mehra A, Dua D, Chakrabarti S, Bhalla A, Puri GD. New consultation liaison model of providing care to COVID patients. Asian J Psychiatr 2020; 54:102437. [PMID: 33271717 PMCID: PMC7546647 DOI: 10.1016/j.ajp.2020.102437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Devakshi Dua
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Goverdhan Dutt Puri
- Department of Anesthesia & Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Gowda GS, Chithra NK, Moirangthem S, Kumar CN, Math SB. Homeless persons with mental illness and COVID pandemic: Collective efforts from India. Asian J Psychiatr 2020; 54:102268. [PMID: 32622032 PMCID: PMC7313514 DOI: 10.1016/j.ajp.2020.102268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/18/2022]
Abstract
COVID-19 pandemic had made an unprecedented impact worldwide. India has entered into a total lockdown by invoking the special provision of Epidemic Diseases Act of 1897 and Disaster Management Act, 2015. The complete lockdown policy has a direct and indirect impact on Homeless Persons with Mental Illness (HPMI) concerning shelter, basic needs and access to health care, besides the transmission of COVID infection. In this manuscript, we highlight the collective efforts undertaken by both the Government and Civil Society in providing care and protection to HPMI against COVID during the lockdown in India.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India.
| | - Nellai K Chithra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
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Dua D, Grover S. Profile of Patients Seen in Consultation-Liaison Psychiatry in India: A Systematic Review. Indian J Psychol Med 2020; 42:503-512. [PMID: 33354074 PMCID: PMC7735242 DOI: 10.1177/0253717620964970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This review aimed to evaluate all the published studies from India conducted in the consultation-liaison (CL) psychiatry setting to identify the diagnostic patterns and referral rates in this setting. Understanding the same can help in organizing the services and knowing the training needs. MATERIALS AND METHODS A thorough literature search was done in August 2020 using different search engines (PubMed, Medknow, and Google Scholar). This was followed by an individual search of various Indian Psychiatry journals and a hand search of references in the available articles. Only those studies that described patients referred to psychiatry services from various specialties were included. RESULTS A total of 33 studies were selected for the review. More than half of them were published in the last 5 years. Studies have primarily reported psychiatric profile medically ill inpatients referred to CL psychiatry services, with the majority of the studies reporting the number of patients seen for the duration of at least 1 year. The referral rates for inpatients across different institutes have varied from 0.01% to 3.6%. The referral rates from emergency set-ups have varied from 1.42% to 5.4%, and in outpatients, from 0.06% to 7.17%. The most commonly diagnosed psychiatric disorders across different studies include depression; organic disorders, including delirium; substance use; intentional self-harm; and anxiety disorders. CONCLUSIONS A limited number of studies have reported the profile of patients seen in CL psychiatry setups. Available data from these studies suggest that referral rates to psychiatry services from other specialists are dismal. There is an urgent need to change the focus of psychiatry training at both undergraduate and the postgraduate levels to enhance the psychiatric knowledge of physicians to improve psychiatry referrals.
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Affiliation(s)
- Devakshi Dua
- Dept. Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Dept. Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mudgal V, Rastogi P, Niranjan V, Razdan R. Pattern, clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital: a descriptive study. Gen Psychiatr 2020; 33:e100177. [PMID: 32596643 PMCID: PMC7304793 DOI: 10.1136/gpsych-2019-100177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
Background Consultation liaison psychiatry (CLP) as a subspecialty is defined as the area of clinical psychiatry that encompasses clinical understanding, teaching and research activities of psychiatrists and allied health professionals in the non-psychiatric divisions of a general hospital. Psychiatric comorbidity of inpatients in tertiary care hospitals is huge. However, the amount of research in India in the field of consultation liaison is strikingly low. Aim To investigate the sociodemographic profile and psychiatric and physical subtypes of illness in patients admitted in other departments and referred to psychiatry department. Methods The study population comprised all consecutive inpatients referred for psychiatric consultation from other departments of a multispecialty tertiary care teaching hospital over 3 months. In a semistructured proforma, sociodemographic profile, referring departments, reasons for referral, referral rate, psychiatric diagnosis and physical illness diagnosis were recorded and analysed using descriptive statistics. Results 172 patients were included and assessed after referral from various departments, of which 56.4% were male and 43.6% were female. The mean age was about 33.95 years, with majority of the patients in the 21-30 years age group. The referral rate was 1.1%. The maximum referrals were from the medicine department, with abnormal behaviour (26.2%) being the most common reason for referral, followed by alleged suicide attempt or self-harm (24.4%), anxiety (10.5%), substance use (10%) and disorientation (7.6%). The most common psychiatric disorder among patients was depressive disorder (24.4%), followed by substance use disorder (19.7%), schizophrenia and psychotic disorder (9.3%), and stress and trauma-related disorder (8.1%). Conclusion There are very few psychiatry referrals and an alarmingly low referral rate, given the psychiatric morbidities in the medical setting. Psychiatry training should have more weightage across different medical specialties and liaison activities between psychiatry and other disciplines should be augmented, which can lead to a better understanding of psychiatric symptomatology, early symptom recognition, swift referral and ensuring follow-up, which, in turn, would be key to improving CLP services.
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Affiliation(s)
- Varchasvi Mudgal
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Pali Rastogi
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Vijay Niranjan
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Ramghulam Razdan
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
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Grover S, Dua D, Sahoo S, Mehra A, Nehra R, Chakrabarti S. Why all COVID-19 hospitals should have mental health professionals: The importance of mental health in a worldwide crisis! Asian J Psychiatr 2020; 51:102147. [PMID: 32473537 PMCID: PMC7199675 DOI: 10.1016/j.ajp.2020.102147] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
COVID-19 pandemic has led to a worldwide crisis. At present, everyone is focusing on the prevention of COVID-19 infection, preparing and discussing issues related to physical health consequences. However, it is important to understand that the life-threatening negative physical health consequences are going to be faced by a few, but everyone is going to face the negative mental health consequences of the pandemic. At various places COVID-19 hospitals are being established, to address the physical health consequences of the pandemic. However, mental health professionals have not been very actively involved in the management of people going through this pandemic. This viewpoint discusses the mental health consequences of the pandemic for the health care workers, people who are undergoing quarantine, people who are admitted to the COVID-19 hospitals, and those who have recovered from the infection. The article also highlights the mental health needs of people at different levels and the kind of interventions, which may be carried out.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
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De Sousa A, Mohandas E, Javed A. Psychological interventions during COVID-19: Challenges for low and middle income countries. Asian J Psychiatr 2020; 51:102128. [PMID: 32380441 PMCID: PMC7195042 DOI: 10.1016/j.ajp.2020.102128] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/25/2022]
Abstract
At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from China has spread to the world. There have been increasing numbers of confirmed cases and deaths around the globe. The COVID-19 pandemic has paved the way for considerable psychological and psychosocial morbidity among the general public and health care providers. An array of guidelines has been put forward by multiple agencies for combating mental health challenges. This paper addresses some of the mental health challenges faced by low and middle income countries (LMIC). It is worthwhile to note that these are challenges at the current stage of the pandemic and may change with the course of the pandemic itself.
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Affiliation(s)
- Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India.
| | - E Mohandas
- Sun Medical and Research Centre, Trichur, Kerala, India
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
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De Sousa A, Lodha P. Mental health perspectives of COVID-19 and the emerging role of digital mental health and telepsychiatry. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2020. [DOI: 10.4103/amhs.amhs_82_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chadda RK, Deb KS, Mahapatra A, Gupta R. Referral patterns in a consultation liaison psychiatry service in India: A comparison with the Western world. Gen Hosp Psychiatry 2019; 59:76-77. [PMID: 30745228 DOI: 10.1016/j.genhosppsych.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/14/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Koushik Sinha Deb
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ananya Mahapatra
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rishi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
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Abstract
Consultation-liaison psychiatry (CLP) is a young and upcoming subspecialty of psychiatry. When one looks at the history of CLP in India, the progress in the area of CLP paralleled that seen in various developed countries. However, over the years, compared to developed countries, CLP started lagging behind in India. In India, CLP services are mostly been provided as per the consultation model and true liaison model practice is missing. There has been meager research in the area of CLP in India, and there is marked heterogeneity in training across different centers. There is lack of specialized training programs in this country. Considering the increasing emphasis on providing person-centered care, there is a need to shift the focus of training from identifying and managing only primary psychiatric disorders to interphase of psychiatry and other disciplines.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Elwadhi D, Gupta H, Ahmed Z, Jiloha R. Consultation-liaison psychiatry in newly established general hospital psychiatry unit: Scope and suggestions. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2019. [DOI: 10.4103/jmhhb.jmhhb_43_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hashim U, Kumar RS, Philip M. Consultation-liaison psychiatric service utilization by suicide attempters. Indian J Psychiatry 2018; 60:427-432. [PMID: 30581207 PMCID: PMC6278216 DOI: 10.4103/psychiatry.indianjpsychiatry_471_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT There is sparse Indian literature on consultation-liaison psychiatric (CLP) service utilization by suicide attempters who generally present first to the accident and emergency departments and are seen by the psychiatrist only after the initial stabilization. AIMS The aim of the study is to study the psychiatric referral, review, and psychopharmacological intervention rates among suicide attempters and to study factors associated with psychiatric referral. SETTINGS AND DESIGN Retrospective, medicolegal case register-based, explorative analysis of suicide attempters presents to a rural tertiary care hospital in south India. SUBJECTS AND METHODS Eight hundred and twenty-nine medicolegal case files of individuals whose diagnosis was recorded as either suicidal attempt, deliberate or intentional self-harm, and poisoning or hanging were analyzed for different variables. STATISTICAL ANALYSIS USED Descriptive frequencies, Pearson's Chi-square and logistic regression analysis to know the association of psychiatric referral with different variables, were performed using the Statistical Package for the Social Sciences, version 16. RESULTS A little more than half of the suspected suicide attempters (51.4%) were referred for psychiatric review, and majority of those referred (93.7%) were reviewed by the psychiatrist. Psychiatric referral was significantly associated with a relatively younger age, positive past and family history of suicidal behavior, mode of attempt (pesticide poisoning and attempted hanging were more likely to be referred), and a longer duration of hospitalization. CONCLUSIONS The low referral rate but an overwhelming review rate among those referred shows that probably referrer factors are responsible for this and so CLP for suicide attempters needs to be strengthened by sensitizing the referring doctors on the importance of the psychiatric referral and the need to avoid discharge within the first 24 h.
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Affiliation(s)
- Uzma Hashim
- Department of Psychiatry, Institute of Naval Medicine, INHS Asvini, Colaba, Mumbai, India
| | - Ravi S Kumar
- Department of Psychiatry, Koppal Institute of Medical Sciences, Koppal, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, NIMHANS, Bengaluru, Karnataka, India
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Abstract
AIM The aim of this study was to evaluate the consultation-liaison psychiatry (CLP) training and services in India. METHODOLOGY An online survey was conducted involving at least one faculty member from the department of psychiatry working in various institutes providing postgraduate training in psychiatry. RESULTS A total of 90 faculty members from different postgraduate institutes across the country participated in the online survey. In three-fourth of the institutes, the CLP services were provided in the form of on-call services with a three-tier system (i.e., CLP team comprising of faculty member, a senior resident, and a junior resident) existing in only about one-third of the institutes. In majority (60%) of the institutes, junior resident was the first-line person responding to the call of other specialists. On an average, CLP teams receive 7.33 calls per day from various clinical departments with a range of 0-20. Among the three most common psychiatric syndromes seen in CLP setting, delirium figured as one of the three most common diagnoses among 79 (87.8%) institutes, and this was followed by substance use disorders (70%), self-harm (60%), and depression (38.9%). Specific CLP posting for junior and senior residents exists only in 28.9% and 12.2% of the institutes, respectively. Joint academic activities with other departments are conducted in 42.2% of the institutes. Regarding research, very few research projects are carried out in the area of CLP. Majority of the participants felt that CLP should be given equal importance or more importance than other subspecialties such as child psychiatry, addiction psychiatry, and geriatric psychiatry in postgraduate training programs. Almost all the participants felt that having good knowledge of CLP helps in managing psychiatric patients in better way. All the participants reported that improving focus on CLP psychiatry will help in reducing stigma attached to mental illnesses and improve the training of postgraduates and the undergraduates. CONCLUSIONS There is a need to improve the CLP services, training program, and research in various medical institutes to provide good mental healthcare to medically ill patients.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Grover S, Sahoo S, Aggarwal S, Dhiman S, Chakrabarti S, Avasthi A. Reasons for referral and diagnostic concordance between physicians/surgeons and the consultation-liaison psychiatry team: An exploratory study from a tertiary care hospital in India. Indian J Psychiatry 2017; 59:170-175. [PMID: 28827863 PMCID: PMC5547857 DOI: 10.4103/psychiatry.indianjpsychiatry_305_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams. AIM This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team. MATERIALS AND METHODS Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team. RESULTS In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ < 0.3) for depressive disorders and delirium and better for the diagnosis of substance dependence (κ = 0.678) and suicidality (κ = 0.655). CONCLUSIONS The present study suggests that delirium is the most common diagnosis in referrals made to CL psychiatry team, and there is poor concordance between the psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivali Aggarwal
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shallu Dhiman
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Padhy SK, Mishra S, Sarkar S, Bang LG, Panigrahi M. Comparison of psychiatric morbidity in patients with irritable bowel syndrome and non-ulcer dyspepsia. Ind Psychiatry J 2016; 25:29-34. [PMID: 28163405 PMCID: PMC5248416 DOI: 10.4103/0972-6748.196038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS The present study aimed to find psychiatric morbidity, stress, anxiety, and depression in patients with irritable bowel syndrome (IBS) and compare it with patients having non-ulcer dyspepsia (NUD). METHODS This case NUD study compared 50 patients each with IBS and NUD. The two groups were compared on demographic data, psychiatric diagnosis using the Structured Clinical Interview for DSM-IV Axis 1 disorders, anxiety levels using the Hamilton Anxiety Rating Scale (HAM-A), and depression using the Hamilton Depression Rating Scale (HAM-D). The Presumptive Stressful Life Events Scale (PSLES) was used to measure stress. RESULTS The cases of IBS were more likely to be of female gender (P = 0.012), married (P = 0.009), and employed (P < 0.001). Psychiatric diagnoses were more common in the cases of IBS than NUDs (88% vs. 30%, P < 0.001), the most common being major depression and somatization disorder. Symptoms of anxiety and depression were more common in patients with IBS (P < 0.001 for HAM-A and HAM-D). Logistic regression revealed that having IBS and increased age were independent predictors of having a psychiatric diagnosis. CONCLUSIONS IBS is associated with the considerable degree of psychiatric morbidity. Adequate attention should be paid toward comorbid psychiatric illnesses, and prompt treatment should be instituted.
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Affiliation(s)
- Susanta Kumar Padhy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Siddharth Sarkar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Late Govind Bang
- Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Mahima Panigrahi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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Grover S, Sarkar S, Avasthi A, Malhotra S, Bhalla A, Varma SK. Consultation-liaison psychiatry services: Difference in the patient profile while following different service models in the medical emergency. Indian J Psychiatry 2015; 57:361-6. [PMID: 26816424 PMCID: PMC4711235 DOI: 10.4103/0019-5545.171854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To compare "consultation" and "hybrid" models of consultation-liaison (CL) services provided to patients visiting the medical emergency outpatient services. MATERIALS AND METHODS Over the period of 18 months, two different models of consultation psychiatry services (July 2012 to March 2013-consultation model, April 2013 to December 2013 hybrid model) were compared. In the consultation model, the psychiatry resident was available on call to the internists. Whereas, for the hybrid model psychiatry resident was stationed in the medical emergency and was available to assess the patients directly requiring psychiatric evaluation. RESULTS During the first 9 months, 22,000 patients were evaluated in various emergency medical outpatient services, of which 383 (1.74%) were referred to the on-call psychiatry CL team. However, when the hybrid model was followed, the number of patients evaluated by the psychiatry resident increased to 594 out of 24,737 patients (2.4%) who reported to the emergency during the next 9 months period. There was a substantial increase in the proportion of cases with medical illnesses for which psychiatric consultation was sought, and a change in psychiatric diagnostic profile was observed too. When compared to the consultation model, the hybrid model was associated with greater use of medications, investigations, referrals and psychological measures in the emergency setting itself. CONCLUSIONS Following a hybrid model in the medical emergency leads to an increase in the number of total psychiatric consultations and more extensive management of patients.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Sarkar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash K Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Watve V. Current challenges in practice of psychiatry in India. Indian J Psychiatry 2015; 57:125-30. [PMID: 26124517 PMCID: PMC4462780 DOI: 10.4103/0019-5545.158132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Vidyadhar Watve
- Consultant Psychiatrist, Poona Hospital & Research Centre, Pune, Maharashtra, India
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Souza JD, Assad FB, Barbosa SP, Badagnan HF, Almeida LYD, Garla CC. Mental health care situation in family health units: perceptions of community health agents. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015002850013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This was a qualitative, descriptive study, performed with 17 Community Health Agents. The aim was to analyze the perception of these professionals regarding the most frequent mental health cases in the region. Data was collected through observation of the region and two focus groups. We used the structuralist perspective for the analysis. The results showed that these professionals perceived mental health demands from an expanded concept of health, in which the resources fit together between the various sectors. They deal with difficulties, develop actions based on soft technologies and do not necessarily focus on the disease. It was concluded that these elements reinforce the power of the Community Health Agents as performers of mental health care practices and as an important link between the healthcare service and the community.
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González-Salas I, Bustamante-Rojano J, Jiménez-Correa U, Gámez-Mier C. Psiquiatría de Enlace. Experiencia en el Hospital General de México. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2014. [DOI: 10.1016/j.hgmx.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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