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Mamtani H, Jain K, Reddy P, Arasappa R, Ganjekar S, Thippeswamy H, Bhat M, Netravathi M, Desai G. The co-occurrence of multiple sclerosis and bipolar disorder: A case series on clinical and neuroimaging correlates. Asian J Psychiatr 2024; 96:104041. [PMID: 38615578 DOI: 10.1016/j.ajp.2024.104041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/16/2024]
Abstract
There is a dearth of studies on neuroimaging correlates of Bipolar Disorder (BD) in Multiple Sclerosis (MS). We describe the clinical profile and neuroimaging findings of four cases of MS with BD. Among them, two patients had multiple mood episodes preceding the neurological symptoms, one had concurrent manic and neurological symptoms, and one had multiple depressive episodes and an isolated steroid-induced manic episode. Frontal and temporal lobes, and Periventricular White Matter were involved in all four cases, and hence may be considered biological substrates of BD in MS. Larger studies are needed to validate the utility of these findings.
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Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Kshiteeja Jain
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Preethi Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Maya Bhat
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
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Narasimhappa K, Mamtani H, Jain K, Holla VV, Ganjekar S, Manjunath N, Kulanthaivelu K, Desai G. Unmasking bipolarity in recurrent depressive disorder following herpes simplex virus triggered n-methyl-D-aspartate encephalitis. Bipolar Disord 2024; 26:192-195. [PMID: 37973382 DOI: 10.1111/bdi.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Herpes simplex virus (HSV) infection triggered n-methyl-D-aspartate (NMDA) encephalitis can lead to varied neuropsychiatric manifestations, including movement disorders and manic symptoms. HSV is known to affect the same brain regions as in secondary mania. METHOD We present a 35-year-old female diagnosed with recurrent depressive disorder (RDD) who developed NMDA encephalitis triggered by HSV infection. RESULT HSV-triggered NMDA encephalitis led to a manic switch in a woman with RDD on antidepressants, along with the new onset of dyskinetic movements. CONCLUSION A neurological insult predisposed our patient to the variable effects of antidepressant drugs.
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Affiliation(s)
- Karthik Narasimhappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Kshiteeja Jain
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Netravathi Manjunath
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Karthik Kulanthaivelu
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Fellmeth G, Kanwar P, Sharma D, Chawla K, DasGupta N, Chhajed S, Chandrakant, Jose EC, Thakur A, Gupta V, Bharti OK, Singh S, Desai G, Thippeswamy H, Kurinczuk JJ, Chandra P, Nair M, Verma A, Kishore MT, Alderdice F. Women's awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study. BMC Psychiatry 2023; 23:829. [PMID: 37957589 PMCID: PMC10644637 DOI: 10.1186/s12888-023-05323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women's awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. METHODS Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. RESULTS Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. CONCLUSIONS Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in 'real world' antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.
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Affiliation(s)
- Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pankaj Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Diksha Sharma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | | | - Neha DasGupta
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shreyash Chhajed
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Chandrakant
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Emily C Jose
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Anita Thakur
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Vikesh Gupta
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Omesh Kumar Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, Shimla, India
| | - Sukhjit Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ashok Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - M Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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AnnajiGowda HH, Vajawat B, Banerjee D, Desai G. Correction: Perceived Barriers in the Assessment and Management of Female Sexual Dysfunction: a Survey Among Resident Trainees in Psychiatry. Acad Psychiatry 2023; 47:455. [PMID: 37442890 DOI: 10.1007/s40596-023-01822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
| | - Bhavika Vajawat
- National Institute of Mental Health & Neurosciences, Bangalore, India.
| | - Debanjan Banerjee
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Geetha Desai
- National Institute of Mental Health & Neurosciences, Bangalore, India
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Todowede O, Afaq S, Adhikary A, Kanan S, Shree V, Jennings HM, Faisal MR, Nisar Z, Khan I, Desai G, Huque R, Siddiqi N. Barriers and facilitators to integrating depression care in tuberculosis services in South Asia: a multi-country qualitative study. BMC Health Serv Res 2023; 23:818. [PMID: 37525209 PMCID: PMC10391993 DOI: 10.1186/s12913-023-09783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/03/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Depression is common among people with tuberculosis (TB). The condition is typically unrecognised or untreated despite available and effective treatments in most low- and middle-income countries. TB services in these countries are relatively well established, offering a potential opportunity to deliver integrated depression screening and care. However, there is limited evidence on how such integration could be achieved. This study aimed to understand the barriers and facilitators to integrate depression care in TB services. METHODS We conducted nine workshops with 76 study participants, including people with TB, their carers, and health service providers in Bangladesh, India, and Pakistan, seeking views on integrating depression care into TB clinics. We used a deductive thematic approach to analyse the translated transcripts of audio recordings, contemporaneous notes made during workshops for Bangladesh and India and workshop reports for Pakistan. Using the SURE (Supporting the Use of Research Evidence) thematic framework, we extracted and categorised barriers and facilitators into various domains. RESULTS Reported barriers to integrating depression care in TB services included lack of knowledge about depression amongst patients and the staff, financial burden, and associated stigma for people with TB and their carers. Government buy-in and understanding of how to identify and screen for depression screening were potential facilitators reported. Additionally, breaking through mental health stigma and providing the additional resources required to deliver this service (human resources and consultation time) were essential for integrating depression and TB care. CONCLUSIONS Depression is a common condition found among people with TB, requiring early identification among people with TB. Integrating depression care into Tb services by health workers requires the availability of political support and the provision of resources.
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Affiliation(s)
- Olamide Todowede
- University of York, York, England, UK
- University of Nottingham, Nottingham, England, UK
| | - Saima Afaq
- University of York, York, England, UK.
- School of Public Health, Faculty of Medicine, Imperial College London, London, England, UK.
- Khyber Medical University, Peshawar, Pakistan.
| | - Anoshmita Adhikary
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Vidhya Shree
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | | | - Zara Nisar
- Khyber Medical University, Peshawar, Pakistan
| | - Ikram Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Geetha Desai
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Najma Siddiqi
- University of York, York, England, UK
- Hull York Medical School, York, England, UK
- Bradford District Care NHS Foundation Trust, Bradford, England, UK
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Bhide SR, Bhargav H, Gangadhar BN, Desai G. Exploring the Therapeutic Potential of Yoga Philosophy: A Perspective on the Need for Yoga-Based Counselling Program (YBCP) in Common Mental Disorders. Indian J Psychol Med 2023; 45:420-429. [PMID: 37483585 PMCID: PMC10357898 DOI: 10.1177/02537176211051987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Affiliation(s)
- Shree Raksha Bhide
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hemant Bhargav
- Dept. of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Bangalore N. Gangadhar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Saravanan V, Desai G, Satyanarayana VA. Antenatal predictors of postnatal maternal attachment and competence after assisted conception-a prospective cohort study in South India. Arch Womens Ment Health 2023:10.1007/s00737-023-01340-1. [PMID: 37393349 DOI: 10.1007/s00737-023-01340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
The aim of this study is to examine the influence of antenatal factors such as anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women who received assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups-50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2 weeks postpartum; and T3, 3 months postpartum. A final sample of 44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyses were carried out. In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment; perceived stress significantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy.
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Affiliation(s)
- Vaishalee Saravanan
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Veena A Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
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Poreddi V, Gandhi S, Ramachandra, Ganjekar S, Desai G, Chandra PS. Evaluation of a manual-based training program in changing auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health. Indian J Psychiatry 2023; 65:617-625. [PMID: 37485417 PMCID: PMC10358814 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_567_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 04/26/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Globally, maternal mental health has been recognized as a priority public health issue. While it is crucial to integrate maternal mental health into mother and child health services, research on strengthening the knowledge and skills of primary healthcare providers on maternal mental health is limited in India. Aim To evaluate the effectiveness of a manual-based training program in improving auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health. Methods The present study adopted an experimental design among ANMs (N = 110) working at primary health centers, Karnataka, India. The participants were randomly assigned to either experimental group (n = 53) or control group (n = 57). The training program delivered interactive sessions based on a facilitator's manual developed specifically for ANMs in India. The assessments were done in both groups at baseline, after the intervention, at three months and at six months using self-rated questionnaires and a case vignette. The descriptive and inferential statistics were used to analyze the data. Results After the training program the mean knowledge, attitudes and skills scores were significantly increased in the experimental group (P < 0.001) and significant differences were found between the mean scores of the groups at 3 months and 6 months follow-up (P < 0.05). Conclusion The training program was found to have a positive impact in enhancing ANMs' knowledge, attitudes, and skills related to maternal mental health in India as there is dearth for mental health professionals in primary care settings.
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Affiliation(s)
- Vijayalakshmi Poreddi
- College of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Ramachandra
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
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Narayan S, Kishore MT, Satyanarayana V, Bhaskarapillai B, Desai G, Chandra P. Bonding and Infants' Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission. Indian J Psychol Med 2023; 45:250-256. [PMID: 37152397 PMCID: PMC10159554 DOI: 10.1177/02537176231164732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Maternal mental health has specific implications for bonding and infants' mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants' development and quality of life (QOL), in case of mothers with severe mental illnesses in remission. Methods The study included 41 mother-infant dyads from the outpatient perinatal psychiatry services and the mother-baby unit of the current study center. Symptom status, self-reported bonding, mother-infant interactions, and infants' development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively. Results Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants. Conclusion The association between mothers' bonding and infants' mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother-infant bonding, development, and quality of life.
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Affiliation(s)
- Shweta Narayan
- Dept. of Clinical Psychology, NIMHANS,
Bangalore, Karnataka, India
| | - M. Thomas Kishore
- Dept. of Clinical Psychology, NIMHANS,
Bangalore, Karnataka, India
- M. Thomas Kishore, Dept. of Clinical
Psychology, Dr MV Govindaswamy Centre, NIMHANS, Bangalore, Karnataka 560029,
India. E-mail:
| | | | | | - Geetha Desai
- Dept. of Psychiatry, NIMHANS,
Bangalore, Karnataka, India
| | - Prabha Chandra
- Dept. of Psychiatry, NIMHANS,
Bangalore, Karnataka, India
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Arora S, Reddy PV, Desai G, Kesavan M, Chandra PS. Valproate prescription among reproductive age women with bipolar disorders-Are regulatory methods the only solution? Bipolar Disord 2023; 25:249-250. [PMID: 36843447 DOI: 10.1111/bdi.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Simran Arora
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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11
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Patwal R, Jolly AJ, Kumar A, Yadav R, Desai G, Thippeswamy H. Diagnostic accuracy of clinical signs and investigations for functional weakness, sensory and movement disorders: A systematic review. J Psychosom Res 2023; 168:111196. [PMID: 36868109 DOI: 10.1016/j.jpsychores.2023.111196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Patients with functional neurological disorders (FND) present with weakness, sensory or movement disorder without corresponding brain pathology. The current classificatory systems suggest an inclusionary approach to diagnose FND. Hence, there is a need to systematically evaluate the diagnostic accuracy of clinical signs and electrophysiological investigations in view of the lack of gold standard tests to diagnose FND. METHODS PubMed and SCOPUS databases were searched for studies published from Jan 1950 to Jan 2022 which reported the diagnostic accuracy of clinical signs and electrophysiological investigations in patients with FND. The Newcastle Ottawa scale was used to assess the quality of the studies. RESULTS Twenty-one studies (727 cases and 932 controls), of which 16 reported clinical signs and, five reported electrophysiological investigations, were included in the review. Two studies were of good quality, 17 of moderate quality, and two of poor quality. We identified 46 clinical signs (24 in weakness, 3 in sensory, and 19 in movement disorders) and 17 investigations (all in movement disorders). Specificity values for signs and investigations were comparatively high compared to the wide variance in sensitivity values. CONCLUSION Electrophysiological investigations appear to have a promising role in diagnosing FND, particularly functional movement disorders. The combined use of individual clinical signs and electrophysiological investigations may support and improve diagnostic certainty of FND. Future research can focus on improving the methodology and validating the existing clinical signs and electrophysiological investigations to enhance the validity of the composite diagnostic criterias for FND diagnosis.
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Affiliation(s)
- Rahul Patwal
- Department of Psychiatry, NIMHANS, Bengaluru, India
| | | | - Amit Kumar
- Department of Psychiatry, NIMHANS, Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, NIMHANS, Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, NIMHANS, Bengaluru, India
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Mehrotra K, Bhola P, Desai G. Contextualizing motherhood in persons with borderline personality vulnerabilities: cultural adaptation of the parent development interview-revised in an Indian context. Res Psychother 2023; 26. [PMID: 36786229 DOI: 10.4081/ripppo.2023.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
An understanding of the complex intersection of borderline personality vulnerabilities and motherhood calls for an integrative and culture-sensitive lens in assessment and therapeutic interventions. The aim of the study was to explore constructions of motherhood in an Indian context to inform the adaptation of the Parent Development Interview-Revised (PDI-R) for use with mothers with borderline personality vulnerabilities. A stepwise framework was followed to obtain conceptual, semantic, and operational equivalences for the PDI-R adaptation. Interviews on contextualised aspects of motherhood were conducted with a sample of eight mental health practitioners specializing in borderline personality disorders, women's mental health or child psychology, two cultural psychologists, one gynaecologist and one paediatrician. Six emergent themes were identified through thematic analysis, 'The ideal mother and her search for identity,' 'Mothering the mother and the vicissitudes of care,' 'Not just mine - negotiating boundaries,' 'Mother knows best,' 'Food, feeding and embodied nurturing,' and 'Approaching motherhood in the clinic.' The proposed adaptations to the PDI-R were further reviewed by two experts, a clinical psychologist and a psychiatrist specialised in perinatal services. This was followed by the process of operational equivalence through administration of PDI-R with two mothers with borderline personality vulnerabilities and two mothers from the community. The expert review and the administration informed the final adaptation of the PDI-R. A systematic process of adaptation can support the use of measures like the PDI-R in different cultures. A contextual understanding of constructions of motherhood and borderline personality has potential to support meaningful assessment and targeted parenting interventions.
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Affiliation(s)
- Kanika Mehrotra
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore.
| | - Poornima Bhola
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore.
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore.
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Ganjekar S, Moirangthem S, Kumar CN, Desai G, Bada Math S. Reproductive rights of women with intellectual disability in India. Indian J Med Ethics 2023; VIII:53-60. [PMID: 36519358 DOI: 10.20529/ijme.2022.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The reproductive rights of women with intellectual disability (WID) are a matter of concern for all stakeholders, including the woman herself, caregivers, guardians and her treating physicians. The judicial system often calls upon psychiatrists to opine regarding the "capacity to consent" of a WID to procedures such as medical termination of pregnancy and permanent sterilisation. Apart from physical and obstetric examinations, assessment of mental status and intelligence quotient (IQ) are also carried out to facilitate an understanding of the above issue. The Rights of Persons with Disabilities Act, 2016, (RPwD) and the Mental Healthcare Act, 2017, elucidate what constitutes free and informed consent as well as how to assess capacity. The assessment process of "capacity to consent" to reproductive system procedures among WID is important and can guide clinicians. Before assessing capacity, the treating physicians should educate a WID with appropriate information on the proposed procedure, its risks and benefits through various means of communication and then evaluate the "capacity to consent" to the procedure. This article summarises the provisions of the existing legislations on the reproductive rights of WID and puts forward guidance for clinicians on how to approach the issue.
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Affiliation(s)
- Sundarnag Ganjekar
- Additional Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Sydney Moirangthem
- Additional Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Channaveerachari Naveen Kumar
- Professor of Psychiatry, Head, Community Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Geetha Desai
- Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Suresh Bada Math
- Professor of Psychiatry, Head, Forensic Psychiatry Services and Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
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Banerjee D, Arasappa R, Chandra PS, Desai G. "It seemed like my fault for wanting to become a mother …"-Experiences and perceptions related to motherhood in women with severe mental illness. Asia Pac Psychiatry 2022; 14:e12519. [PMID: 35899683 DOI: 10.1111/appy.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with mental illness experience unique challenges during their motherhood. However, little is known about their own perceptions and unmet needs in the process of childbearing. A qualitative study design with a social constructivist paradigm was used to explore lived experiences of mothers with severe mental illness (SMI) during the childbearing period. METHODS Semi-structured in-depth interviews were conducted with 30 mothers recruited through purposive sampling. This was followed by inductive thematic analysis. Rigor was established through triangulation and respondent validation. This paper focuses on the perceptions during the pre-conception and pregnancy period. RESULTS Emergent categories (themes) were thoughts/feelings about childbearing (ambivalence about being a mother/having a baby, fantasies about childbearing/rearing, guilt about pregnancy), the impact of mental illness (stigma, effect of symptoms on their self-care including healthcare, concerns about effect of medications on fetus), unmet needs (lack of emotional support, unanswered doubts about effects of illness on pregnancy, child and motherhood, wanting to be considered as "potential mothers"), and caregivers' reactions (discrimination, anger/abuse, selective support). The centrality of motherhood and balancing the "dual role" of a patient and mother were the overarching categories after analysis. CONCLUSION Mothers with SMI prize motherhood but navigate through it with various adverse experiences. The results of this study, grounded in their voices, provide critical insights for service and policy provisions in perinatal psychiatry.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Patwal R, Pai NM, Ganjekar S, Udupi GA, M P, M S, Kesavan M, Desai G. Atypical idiopathic NBIA (neurodegeneration with brain iron accumulation) associated with treatment-resistant bipolar mania responding to clozapine. Bipolar Disord 2022; 24:840-843. [PMID: 36164835 DOI: 10.1111/bdi.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Rahul Patwal
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Naveen Manohar Pai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Gautham Arunachal Udupi
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Pooja M
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sandhya M
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Nanjundaswamy MH, Gowda SM, Ganjekar S, Thippeswamy H, Desai G, Chandra PS. Women with mental illness seeking conception counselling at a specialist perinatal psychiatry service in India. Asian J Psychiatr 2022; 78:103313. [PMID: 36356427 DOI: 10.1016/j.ajp.2022.103313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
AIMS To study the clinical and sociodemographic profile of women with mental illness seeking conception counselling at perinatal psychiatry service. To compare women seeking preconception counselling (PCC) to that of those who sought help after unplanned pregnancy with exposure (UPE) to psychotropics. MATERIAL AND METHODS Data was extracted from the clinical records of women between the year 2014-2017 who attended perinatal outpatient services. The details collected included sociodemographic details, illness details, contraception, infertility treatment and detailed treatment history. RESULTS Of the 766 women who consulted perinatal psychiatry services (2014-17), 179 (23.37%) had consulted for conception counselling. Out of that 104 (58.1%) sought PCC, and 75 (41.9%) had UPE to psychotropics. PCC was sought by women with higher education, those having a severe mental illness, and a longer duration of illness. Women with medical comorbidities and receiving infertility treatment also sought PCC. Also, women who had earlier undergone PCC been more likely to seek PCC for further pregnancies. CONCLUSIONS Women with mental illness should be counselled regarding planned pregnancies, contraception, and the impact of psychotropics on pregnancy and foetus. Also, liaison with other specialities like obstetricians, sonologist and paediatricians is essential.
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Affiliation(s)
- Madhuri H Nanjundaswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | | | - Sundarnag Ganjekar
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Harish Thippeswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Prabha S Chandra
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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Vishwanathan A, Kashyap H, Reddy RP, Philip M, Thippeswamy H, Desai G. Neurocognition and Metacognition in Anxiety Disorders. Indian J Psychol Med 2022; 44:558-566. [PMID: 36339691 PMCID: PMC9615456 DOI: 10.1177/02537176211072408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neurocognitive deficits are noted in anxiety disorders (ADs), albeit with several inconsistencies. The relationship between neurocognition and metacognition may have potential implications for understanding cognitive dysfunction but is poorly understood in ADs. This study aimed to examine the relationship between neurocognition and metacognition in ADs, with a cross-sectional design. METHODS The sample included ADs (n = 25) and nonclinical (n = 25) groups matched on age, gender, and education. Neurocognition was assessed using tests for intelligence, attention, working memory, fluency, flexibility, set-shifting, inhibition, planning, and memory; and metacognition using Metacognition Questionnaire-30 (MCQ-30) and Metacognitive Awareness and Regulation Scale (MARS). RESULTS Compared to comparison/normative scores, the anxiety group showed significantly poorer performance on zoo map test (low demand trial; P = 0.007), rule shift cards 1 (P ≤ 0.001), rule shift cards 2 (P ≤ 0.001), and logical memory immediate recall (P ≤ 0.001) and delayed recall (P ≤ 0.001); greater negative beliefs about worry (P = 0.005), and poorer metacognitive awareness and regulation (P = 0.01). Greater cognitive self-consciousness was correlated with better planning (Spearman's rho = -0.509, P = 0.009). CONCLUSIONS Individuals with ADs show neurocognitive difficulties in planning, set-shifting, and logical memory, dysfunctional metacognition, and reduced metacognitive awareness and regulation. Cognitive self-consciousness is linked to better planning. The interrelationships between neurocognition and metacognition may have potential implications for clarifying inconsistent findings and designing novel cognitive interventions in ADs.
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Affiliation(s)
| | - Himani Kashyap
- Dept. of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | | | - Mariamma Philip
- Dept. of Biostatistics, NIMHANS, Bengaluru, Karnataka, India
| | | | - Geetha Desai
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Meena P, Subramanian S, Desai G, Krishna G, Rajeswaran J. EEG-Neurofeedback Training and Prolidase in Anxiety Disorders: An Exploratory Study. NR 2022. [DOI: 10.15540/nr.9.3.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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H A H, Vajawat B, Banerjee D, Desai G. Perceived Barriers in the Assessment and Management of Female Sexual Dysfunction: a Survey Among Resident Trainees in Psychiatry. Acad Psychiatry 2022; 46:347-351. [PMID: 34694591 DOI: 10.1007/s40596-021-01551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The authors examined the perceived barriers in the assessment and management of female sexual dysfunction among resident trainees in psychiatry. METHODS An online survey was conducted among 148 resident trainees in psychiatry at a tertiary academic psychiatry center in India. It consisted of nine items with responses rated on a Likert scale. The anonymity of the responses was maintained. RESULTS A total of 73 residents (49.3%) responded to the survey. Spontaneous reporting of sexual functioning, which is patient-driven, and spontaneous inquiry, which is resident-driven, were lacking. Specific barriers identified in the majority were lack of time, privacy, linguistic challenges, limited knowledge, and sociocultural background of the patient. The gender of the resident was not perceived as a major barrier in a majority. Marital discord appeared as a common response for inquiries into sexual functioning, while the use of psychotropics, the presence of medical comorbidities, and the postmenopausal state did not attract a majority to inquire about the same. Furthermore, a response that there was a lack of intervention in those reporting sexual dysfunction was commonly noted. Only 5.5% of the participants reported having received adequate formal training in the management of female sexual dysfunction. CONCLUSION Female sexual dysfunction is common, adds to psychiatric morbidity, and affects the quality of life. It is important to impart training on female sexual dysfunction as a part of their residency program with cultural appropriateness. A future direction would be to evaluate the effectiveness of a formal training program for assessing and managing female sexual dysfunction.
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Affiliation(s)
- Harshitha H A
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Bhavika Vajawat
- National Institute of Mental Health & Neurosciences, Bangalore, India.
| | - Debanjan Banerjee
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Geetha Desai
- National Institute of Mental Health & Neurosciences, Bangalore, India
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Kumar SV, Narayan S, Malo PK, Bhaskarapillai B, Thippeswamy H, Desai G, Kishore MT. A systematic review and meta-analysis of early childhood intervention programs for developmental difficulties in low-and-middle-income countries. Asian J Psychiatr 2022; 70:103026. [PMID: 35231776 DOI: 10.1016/j.ajp.2022.103026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/11/2022] [Accepted: 02/11/2022] [Indexed: 12/15/2022]
Abstract
Early acknowledgment of developmental difficulties in young children strengthens both preventive and therapeutic approaches. Despite their feasibility, early intervention services are limited in Low-and-Middle-Income (LAMI) countries compared to high income countries. The aim of this study was to examine the evidence for early childhood intervention programs for developmental difficulties in children below five years in LAMI countries through a systematic review and meta-analysis. In this background, original studies published in peer-reviewed journals from 2010 to 2019 with a focus on developmental difficulties including delays and deviances; randomized research design with a clear description of the intervention and measurable outcomes, and conducted in LAMI countries were considered for the systematic review. Electronic databases, including ProQuest, PubMed, Ovid, EBSCOhost, and Google Scholar, were searched using a combination of specific keywords. PRISMA guidelines were followed to include the studies. Each of the selected study was assessed for quality before applying appropriate statistics to synthesize the data. Fourteen publications were identified from 2697 publications for the systematic review, out of which four were found compatible for a meta-analysis. The studies reviewed were conducted in Bangladesh, India, Pakistan, Uganda, Vietnam, and Zambia. A meta-analysis of four studies provided considerable evidence for the effects of early developmental intervention. This systematic review provides an evidence for early childhood intervention programs in LAMI countries. Implications of these findings for the early childhood programs are discussed in this article.
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Affiliation(s)
- Sapna V Kumar
- Junior Research Fellow, ICMR Project, Department of Clinical Psychology.
| | - Shweta Narayan
- Junior Research Fellow, ICMR Project, Department of Clinical Psychology.
| | | | | | | | | | - M Thomas Kishore
- Departmment of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
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Patwal R, Pai NM, Ganjekar S, Arshad F, Alladi S, Sharma MK, Desai G, Chaturvedi SK. Schizencephaly and the Neurodevelopmental Model of Psychosis. Neurol India 2022; 70:740-743. [PMID: 35532651 DOI: 10.4103/0028-3886.344662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Schizencephaly is a rare congenital disorder of cerebral cortical development. Clinical features vary based on the areas and severity of cortical involvement. The most prominent manifestations being motor deficits, seizures, and cognitive impairment. MRI has been the diagnostic modality of choice. Till now, a handful of case reports associating schizencephaly with psychiatric manifestations have been reported. METHODS In this brief report, we review the available literature and present the summary of a 50-year-old gentleman who presented with paranoia, irritability, impulsive spending, emotional lability, and circumstantial speech with perseveration of themes. RESULTS MRI findings are suggestive of closed lip schizencephaly. CONCLUSION This case helps us in understanding the neurodevelopmental model and functional neuroanatomy of psychiatric symptom dimensions.
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Affiliation(s)
- Rahul Patwal
- Departmen of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Naveen Manohar Pai
- Departmen of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Sundarnag Ganjekar
- Departmen of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Faheem Arshad
- Departmen of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Suvarna Alladi
- Departmen of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Manoj Kumar Sharma
- Departmen of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Geetha Desai
- Departmen of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
| | - Santosh K Chaturvedi
- Departmen of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, Karnataka, India
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Suhas S, Sreeraj VS, Amrutha C, Desai G, Venkatasubramanian G. Is allopurinol a marvel in the endgame of ultra-resistant schizophrenia? Schizophr Res 2022; 241:12-13. [PMID: 35066431 DOI: 10.1016/j.schres.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Satish Suhas
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Vanteemar S Sreeraj
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Chandrasegaran Amrutha
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Ganesan Venkatasubramanian
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India.
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Mamtani H, Shiva L, Nanjundaswamy MH, Kamble N, Prasad C, Desai G, Chandra PS, Thippeswamy H. Treatment resistance in bipolar affective disorder with recurrent mania course-Role of periventricular leukomalacia. Bipolar Disord 2022; 24:93-96. [PMID: 34596304 DOI: 10.1111/bdi.13138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | - Chandrajit Prasad
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, NIMHANS, Bangalore, India
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Chandra PS, Bajaj A, Desai G, Satyanarayana VA, Sharp HM, Ganjekar S, Supraja TA, Jangam KV, Venkatram L, Kandavel T. Anxiety and depressive symptoms in pregnancy predict low birth weight differentially in male and female infants-findings from an urban pregnancy cohort in India. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2263-2274. [PMID: 34114109 DOI: 10.1007/s00127-021-02106-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study examined the contributions of antenatal anxiety, depression, and partner violence to low birth weight (LBW) in infants and to sex-specific birth weight outcomes among mothers from a cohort in urban India. METHODS Data from 700 mothers from the PRAMMS cohort (Prospective Assessment of Maternal Mental Health Study) were used. Pregnant women were assessed in each trimester-T1, T2 and T3, for symptoms of anxiety, and depression as well as partner violence. Multivariate analyses were performed for the whole sample and then for male and female infants separately. The final multivariable logistic regression models were each built using a backward selection procedure and controlling for confounders. To accommodate longitudinally measured data, change in scores (T2-T1 and T3-T2) of anxiety and depression were included in the model. RESULTS Of the 583 women with a singleton live birth, birth weight was available for 514 infants and LBW was recorded in 80 infants (15.6%). Of these, 23 infants were preterm. Overall, higher T1 Depression scores (OR: 1.11; 95% CI 1.040, 1.187) and an increase in both Depression scores (OR: 1.12; 95% CI 1.047, 1.195) from T1 to T2 and Anxiety scores (OR: 1.32; 95% CI 1.079, 1.603) between T2 and T3 were predictors of LBW. Female infants had a higher chance of LBW with increase in maternal anxiety between T1-T2 (OR: 1.69; 95% CI 1.053, 2.708) and T2-T3 (OR: 1.49; 95% CI 1.058, 2.086); partner violence during pregnancy just failed to reach conventional statistical significance (OR: 2.48; 95% CI 0.810, 7.581) in girls. Male infants had a higher chance of LBW with higher baseline depression scores at T1 (OR: 1.23; 95% CI 1.042, 1.452) and an increase in depression scores (OR: 1.25; 95% CI 1.060, 1.472) from T1 to T2. CONCLUSION Increasing prenatal anxiety and depressive symptoms in different trimesters of pregnancy were associated with LBW with sex-specific patterns of association in this sample from a Low and Middle Income Country.
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Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Aakash Bajaj
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Veena A Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Helen M Sharp
- Department of Psychological Science, University of Liverpool, Liverpool, UK
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - T A Supraja
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kavita V Jangam
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Latha Venkatram
- Department of Obstetrics, Rangadore Memorial Hospital, Bangalore, India
| | - Thennarasu Kandavel
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
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Fellmeth G, Kishore MT, Verma A, Desai G, Bharti O, Kanwar P, Singh S, Thippeswamy H, Chandra PS, Kurinczuk JJ, Nair M, Alderdice F. Perinatal mental health in India: protocol for a validation and cohort study. J Public Health (Oxf) 2021; 43:ii35-ii42. [PMID: 34622290 PMCID: PMC8498097 DOI: 10.1093/pubmed/fdab162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh). METHODS The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women's knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively. CONCLUSION Improving understanding, detection and management of CMD among women is key to improving women's health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.
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Affiliation(s)
- G Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M T Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - A Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - G Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - O Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, India
| | - P Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - S Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - H Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - P S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - F Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Abstract
Aging is an inevitable physiological process. A significant increase has been noted in the elderly population over the years. Aging population face challenges with physical health conditions, but also mental health problems. Care of the elderly is influenced by health conditions, health services, as well socio cultural factors. Gender plays an important role in the aging process with significant differences noted in the aging process, variations in health conditions as well care received. The current review addresses the role of gender in the aging process and its influence in the prevalence, clinical presentation and course of various mental and physical health conditions in the elderly. The review identifies gaps in understanding the gender perspectives related to long-term elderly care, legal and financial issues. The review emphasizes the necessity to address the gender perspective in aging to adequately meet the health demands of the elderly.
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Affiliation(s)
- Shruti Nair
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Neena Sawant
- Dept. of Psychiatry, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India
| | - Harish Thippeswamy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Jha M, Dumbala S, Gulati K, Bhargav H, Arasappa R, Varambally S, Gangadhar BN, Desai G. Yoga Module for Somatoform Pain Disorders: Development, Content Validation, and Feasibility Testing. Int J Yoga 2021; 14:206-212. [PMID: 35017862 PMCID: PMC8691440 DOI: 10.4103/ijoy.ijoy_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Yoga practices have been found to be useful in chronic pain conditions but studies focussing specifically on somatoform pain disorders (SPDs) are limited. AIMS Current study aims to develop and test the feasibility of a yoga program for patients with SPDs. MATERIALS AND METHODOLOGY Athorough search of traditional and contemporary literature was performed with the objective of formulating a yoga program for reducing chronic non-specific pain and associated psychological distress. Content validity of the program was then determined by taking the opinion of 18 yoga experts (who had >5 years of experience in treating mental health disorders) using content validation ratio (CVR) through Lawshe's formula. The feasibility of the module was tested on 10 subjects diagnosed with SPDs as per the International Classification of Diseases (ICD) -10 criteria using standard scales. RESULTS In the finalized module, 70.83% (34 out of 48 items) of the practices were retained along with the modifications as suggested by the experts. Two practices were not found to be feasible (Trikonasana and Shalabhasana) and hence were removed from the final module. A significant reduction in pain severity was observed in the subjects after practising the yoga module for 2 weeks. The content validity index for the whole module (average of all CVRs) was 0.55. CONCLUSIONS Ayoga module was developed for SPD. The content validity of the module was found to be good. The module was found safe and potentially useful for reducing pain severity in patients with SPD. Future studies should test the efficacy of the developed program through a randomized controlled clinical trial.
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Affiliation(s)
- Monika Jha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sowjanya Dumbala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Kankan Gulati
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - BN Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Nagendrappa S, Vinod P, Pai NM, Ganjekar S, Desai G, Kishore MT, Thippeswamy H, Vaiphei K, Chandra PS. Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India-Challenges and Potential Solutions Based on Two Case Reports. Front Glob Womens Health 2021; 2:648429. [PMID: 34816204 PMCID: PMC8593993 DOI: 10.3389/fgwh.2021.648429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/22/2021] [Indexed: 01/09/2023] Open
Abstract
The ongoing COVID-19 pandemic in India has created several challenges in the care of women with perinatal mental illness. Access to healthcare has been disrupted by lockdowns, travel restrictions, and the unavailability of outpatient services. This report aims to discuss the challenges faced by women with severe mental illnesses during the perinatal period with the help of two case reports. Accordingly, we have highlighted the role of COVID-19 infection as a traumatic event during childbirth and its role in triggering a psychotic episode in women with vulnerabilities; difficulties faced by women with postpartum psychosis in accessing perinatal psychiatry services; and the challenges of admission into an inpatient Mother-Baby Unit (MBU). Further, we have discussed potential solutions from the perspectives of Lower and Middle-income (LAMI) countries that need to be extended beyond the pandemic. They include offering video consultations, reviewing hospital policies, and evolving strategies to mitigate traumatic experiences for pregnant and postpartum women with severe mental illnesses in both obstetric and psychiatric care.
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Affiliation(s)
- Sachin Nagendrappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pratibha Vinod
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naveen Manohar Pai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M. Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India,*Correspondence: Prabha S. Chandra
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Yadawad V, Ganjekar S, Thippeswamy H, Chandra PS, Desai G. Short-term outcome of mothers with severe mental illness admitted to a mother baby unit. Indian J Psychiatry 2021; 63:245-249. [PMID: 34211217 PMCID: PMC8221211 DOI: 10.4103/psychiatry.indianjpsychiatry_1005_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/22/2020] [Accepted: 05/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mother baby psychiatry units (MBUs) are the expected standard of inpatient care internationally for postpartum mothers with severe mental illness (SMI) and favorable outcomes for mother infant dyads have been reported from these services. However, there are very few such units in low- and middle-income countries. The current study aimed to assess the short-term outcome of mothers in SMI admitted to an MBU in India. MATERIALS AND METHODS Mother infant dyads admitted over a year in the MBU were assessed in detail at admission, discharge, and at 3 months. Tools used included the Brief Psychiatric Rating Scale (BPRS), Young's Mania Rating Scale, Edinburgh Postnatal Depression Scale, and Clinical Global Impression. Mother infant interaction was assessed using the NIMHANS maternal behavior scale. RESULTS The mean age of the 43 mothers admitted in this period was 27.3 ± 6.2 years. For 27 (62.8%) mothers, this was a first episode of psychosis. Affective disorders and acute psychotic disorders were the most common diagnoses. The average duration of stay in the MBU was 25 days. While all mothers showed significant improvement at discharge, mothers with a first episode in the postpartum had higher BPRS scores (Ws = 309.5, P = 0.02) as compared to the others. At 3 months following discharge, all mothers sustained the improvement achieved. DISCUSSION Mothers with SMI admitted to an MBU showed significant clinical and dyadic improvement at discharge which was sustained at 3 months. However, the lack of a control group limits the generalizability of the current findings. CONCLUSION The study highlighted a favorable short-term outcome among mothers with SMI admitted to a MBU facility.
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Affiliation(s)
- Vishwas Yadawad
- Department of Psychiatry, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Sagar R, Talwar S, Desai G, Chaturvedi SK. Relationship between alexithymia and depression: A narrative review. Indian J Psychiatry 2021; 63:127-133. [PMID: 34194055 PMCID: PMC8214133 DOI: 10.4103/psychiatry.indianjpsychiatry_738_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/10/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Shivangi Talwar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Banerjee D, Arasappa R, Chandra PS, Desai G. "Hear me out": experiences of women with severe mental illness with their healthcare providers in relation to motherhood. Asian J Psychiatr 2021; 55:102505. [PMID: 33310343 DOI: 10.1016/j.ajp.2020.102505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most women with severe mental illness (SMI) are mothers, however little is known about their own experiences of how the health care providers offer support in handling motherhood. This study attempted to assess the barriers, expectations and facilitators in seeking help from mental health care providers in matters of pregnancy and motherhood using a qualitative methodology. METHODS The study used a qualitative design with social constructivist paradigm to obtain data from 30 mothers with SMI who had children less than five years of age. One-to-one in-depth semi-structured interviews were conducted and inductive thematic analysis was used to explore transcripts using Charmaz's grounded theory. RESULTS Main barriers in seeking help from health care providers were perceived stigma, treatment side-effects, misinterpretations of information and health providers not having enough time. On the other hand self-advocacy, early engagement with the health care system, being psychoeducated and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers were early and direct communication and basic guidance regarding child health and parenting issues. CONCLUSION Women who are mothers and also users of mental health services face special challenges in managing their illness and motherhood. Hearing their voices is essential for service provision and ensuring adequate mental health and handling motherhood.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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33
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Shiva L, Desai G, Satyanarayana VA, Venkataram P, Chandra PS. Negative Childbirth Experience and Post-traumatic Stress Disorder - A Study Among Postpartum Women in South India. Front Psychiatry 2021; 12:640014. [PMID: 34295269 PMCID: PMC8290214 DOI: 10.3389/fpsyt.2021.640014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Negative childbirth experience has been associated with post-traumatic stress disorder (PTSD) and depression in the postpartum period with a significant impact on the mother as well as the infant. Methods: The current study aimed at studying the association of negative child birth experience with PTSD and depressive symptoms among primiparous mothers within 6 weeks of child birth. The Childbirth Experience Questionnaire (CEQ), PTSD checklist (PCL), and Edinburgh Postnatal Depression scale (EPDS) were used to assess negative childbirth experience, symptoms of PTSD, and depression respectively. Results: Of the 95 women in the study, fifty women (52.6%) had a score below the median of CEQ score (score of 72) indicating a negative childbirth experience. Lower Scores on CEQ indicating negative childbirth experience correlated with PTSD scores on the PCL (r = -0.560, p = 0.001) and depression scores on the EPDS (r = -0.536, p = 0.001). Of the sample of 95 women, 7.36% (N = 7) met the criteria for probable PTSD and 3.16% (N = 3) met criteria for partial PTSD. Twelve women (12.6%) had EPDS scores above 13 indicating probable clinical depression. Median CEQ scores were lower among the women who had PTSD or partial PTSD (N = 10) and among the women who had probable depression (N = 12) than those who did not. Childbirth experience emerged as the only predictor of PTSD on logistic regression (p = 0.03) (95% CI 1.17-79.61). Conclusions: Negative childbirth experiences are common and appear to be associated with depressive and PTSD symptoms. These findings emphasize the need to provide good intrapartum care including respectful maternity care for a positive childbirth experience.
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Affiliation(s)
- Lakshmi Shiva
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Veena A Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Padmalatha Venkataram
- Department of Obstetrics and Gynecology, South Bangalore Obstetricians and Gynecologists, Rangadore Memorial Hospital, Bengaluru, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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34
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Affiliation(s)
- Prateek Varshney
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Guru Prasad
- Bowring Hospital, Bengaluru, Karnataka, India
| | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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35
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Bagadia A, Nanjundaswamy MH, Ganjekar S, Thippeswamy H, Desai G, Chandra PS. Factors influencing decision-making around pregnancy among women with severe mental illness (SMI): A qualitative study. Int J Soc Psychiatry 2020; 66:792-798. [PMID: 32579050 DOI: 10.1177/0020764020925104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Decision-making around pregnancy is challenging for women with severe mental illness (SMI), and several clinical and socio-cultural factors might influence this process. AIM The main objective of this study was to determine factors that influence decision-making regarding pregnancy for women with SMI. METHODS Using a qualitative design, 42 women with SMI who were pregnant or planning pregnancy were assessed using a semi-structured interview by an independent researcher not involved in their clinical care. Areas of inquiry included knowledge about their illness, treatment; family and societal beliefs on mental illness and motherhood; illness management; and attitude towards medical advice. RESULTS Among the 42 women, majority of the women (88%) reported reduced autonomy in decision-making related to pregnancy. Stigma was one of the major contributory factors in decision-making. Over 80% reported not using contraception despite medical advice due to lack of control over the decisions related to the use of contraception. Over 50% of the women in the study believed that taking psychotropic medications during pregnancy would definitely harm the baby. A similar number believed that their illness would not recur if medications were to be stopped during pregnancy. CONCLUSION Women with SMI who plan to become pregnant, especially from low-income settings in India, are disadvantaged by stigma and societal expectations, affecting their ability to make optimum decisions during this crucial period. Decision-making around pregnancy in women with SMI is complex and appears to be influenced by several socio-cultural factors and needs to be dealt with sensitively.
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Affiliation(s)
| | - Madhuri H Nanjundaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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Pradeepkumar PC, Hamza A, Ragesh G, Ganjekar S, Thippeswamy H, Chandra PS, Desai G. Psychological Distress, Coping and Perceived Social Support Among Partners of Women with Postpartum Onset Severe Mental Illness (SMI) Admitted to a Mother-Baby Unit. Indian J Psychol Med 2020; 42:535-539. [PMID: 33354079 PMCID: PMC7735251 DOI: 10.1177/0253717620958162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The presence of a severe mental illness in the mother during the postpartum period may impact the whole family and specifically have an effect on the health of the spouse. The current study aimed to assess psychological distress, coping, and perceived social support of spouses of women with postpartum onset severe mental illness. METHODOLOGY A cross-sectional descriptive research design was used, and 30 spouses of the women admitted to the mother-baby unit (MBU) for psychiatric inpatient care were included in the study. The assessments included sociodemographic details, Kessler psychological distress scale (K10), brief coping orientation to problems experienced scale (brief COPE), and Zimets' multidimensional scale of perceived social support. RESULTS Around 50% of the spouses experienced severe psychological distress. Nearly 40% of spouses reported poor coping and 56.7% of spouses had moderate social support from family and friends. CONCLUSION The findings indicate the need to address distress and coping in spouses of women with postpartum onset SMI.
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Affiliation(s)
- PC Pradeepkumar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ameer Hamza
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - G Ragesh
- Institute of Mental Health and Neurosciences, Govt Medical College Campus, Kozhikode, Kerala, India
| | - Sundarnag Ganjekar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Harish Thippeswamy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Geetha Desai
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Affiliation(s)
- Pawan Arun Khadse
- Centre for Addiction Medicine, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Guru S Gowda
- Centre for Addiction Medicine, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Centre for Addiction Medicine, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Centre for Addiction Medicine, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Centre for Addiction Medicine, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Ragesh G, Ganjekar S, Thippeswamy H, Desai G, Hamza A, Chandra PS. Feasibility, Acceptability and Usage Patterns of a 24-Hour Mobile Phone Helpline Service for Women Discharged from a Mother-Baby Psychiatry Unit (MBU) in India. Indian J Psychol Med 2020; 42:530-534. [PMID: 33354078 PMCID: PMC7735230 DOI: 10.1177/0253717620954148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For women with perinatal mental illness, phone helplines may be a useful way of accessing help. This study assessed the feasibility, acceptability, limitations, and usage patterns of a helpline service for mothers discharged from a mother-baby psychiatry unit. METHODS Mothers discharged from a mother baby unit during an 18-month period were provided with a helpline number. A social worker answered the calls. Details of the calls, including the reasons and the interventions provided, were recorded. Feasibility and acceptability were assessed by calling all users and nonusers. Satisfaction with the helpline was recorded among users, and reasons for not calling were assessed among nonusers. RESULTS Among 113 mothers, 51 (45%) made 248 calls. Calls were regarding medication, sleep problems, planning pregnancies, symptom exacerbation, appointments, and suicidal ideation. Some calls were related to domestic violence (n = 13, 5.24%), and infant health and breastfeeding (n = 11, 4.44%). Seventy-six (67%, 44 callers and 32 noncallers) were contacted. The majority (41/44) of the callers found it useful: 91% said they got help, and 95% said they would recommend it to others. However, language difficulties (9%) and technical problems (5%) were reported. Among the noncallers, the majority reported having experienced no problem related to mental health or had contacted a doctor. However, of the noncallers, one woman died of suicide, did not have access to a phone, and the family did not choose to call. CONCLUSIONS Helpline phone service appears to be feasible and acceptable and can be adapted in other mother-baby psychiatry units in low and middle-income countries. However, in some women, the nonavailability of a phone may be a limiting factor.
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Affiliation(s)
- G Ragesh
- Dept. of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Govt. Medical College campus, Kozhikode, Kerala, India
| | - Sundarnag Ganjekar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Harish Thippeswamy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Geetha Desai
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ameer Hamza
- Retd Additional Professor, Dept. of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Prabha S Chandra
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Nair S, A Satyanarayana V, Desai G. Prevalence and clinical correlates of intimate partner violence (IPV) in women with severe mental illness (SMI). Asian J Psychiatr 2020; 52:102131. [PMID: 32371366 DOI: 10.1016/j.ajp.2020.102131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022]
Abstract
Women with severe mental illness (SMI) are a vulnerable population in whom varying rates of Intimate Partner Violence (IPV) have been reported with impact on their illness. The current study aimed to assess the prevalence and clinical correlates of IPV among women with SMI admitted to a tertiary care psychiatric hospital. The study was a cross sectional assessment of IPV among women with severe mental illness receiving inpatient care. The assessments included Indian Family Violence and Control Scale (IFVCS) for IPV, Brief Psychiatric Rating Scale (BPRS version 4) for psychopathology, The Suicide Behaviours Questionnaire Revised (SBQ-R) for suicidality, Physical Health Questionnaire (PHQ) for physical health, Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms and also semi structured schedule for their sociodemographic profile. A total of 100 women diagnosed with SMI with a cohabiting partner were assessed. The lifetime prevalence of IPV in the women with SMI was 22 %. Last 1-year prevalence of IPV in them was 20 %. Control and emotional violence were the most commonly reported form of violence, followed by physical violence, and sexual violence was the least reported. Significant association of IPV with suicidal behaviour, depression scores, physical health and somatic symptoms were found. IPV is prevalent in women with SMI and needs to be addressed. It is important to assess all types of IPV as it can impact the illness and the lives of these women, overall.
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Affiliation(s)
- Shruti Nair
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Veena A Satyanarayana
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Geetha Desai
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
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Chaturvedi SK, Desai G, Alzahrani SH. Comment on Alzahrani et al. "Prevalence of alexithymia and associated factors among medical students at King Abdulaziz University: a cross-sectional study". Ann Saudi Med 2020; 40:354. [PMID: 32757985 PMCID: PMC7410217 DOI: 10.5144/0256-4947.2020.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Santosh K Chaturvedi
- From the Department of Psychiatry, National Institute of Mental Health And NeuroSciences, Bangalore, Karnataka, India
| | - Geetha Desai
- From the Department of Psychiatry, National Institute of Mental Health And NeuroSciences, Bangalore, Karnataka, India
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Dumbala S, Bhargav H, Satyanarayana V, Arasappa R, Varambally S, Desai G, Bangalore GN. Effect of Yoga on Psychological Distress among Women Receiving Treatment for Infertility. Int J Yoga 2020; 13:115-119. [PMID: 32669765 PMCID: PMC7336944 DOI: 10.4103/ijoy.ijoy_34_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background Infertility among women has been associated with significant psychological distress, anxiety, and depression. yoga therapy has been found to be useful in the management of anxiety, depression and psychological distress. Aim To review studies on the effectiveness of yoga in reducing psychological distress and improving clinical outcomes among women receiving treatment for infertility. Methodology PubMed, ScienceDirect, and Google Scholar databases were searched for studies using the following inclusion criteria: studies published in English, those published between 2000 and 2018, published in peer-reviewed journals, and those with Yoga as an intervention. Review articles, studies without any yoga interventions for infertility, and male infertility were excluded. The keywords included for the literature search were: Yoga, Mindfulness, Relaxation technique, Stress, Distress, Anxiety, Infertility, In Vitro Fertilization (IVF), and Assisted Reproductive Technology (ART). Results Three studies satisfied the selection criteria. Two studies involved Hatha yoga intervention and one study used structured yoga program. The variables assessed in these studies were: (1) anxiety, (2) depression, (3) emotional distress, and (4) fertility-related quality of life. All the studies reported an improvement in the anxiety scores after yoga intervention. Conclusion Yoga therapy may be potentially useful in improving anxiety scores among women suffering from infertility. More studies are needed in this area to establish role of yoga as an adjuvant during the treatment of infertility.
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Affiliation(s)
| | - Hemant Bhargav
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - Rashmi Arasappa
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - Geetha Desai
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Prabha L, Ganjekar S, Gupta V, Desai G, Chaturvedi SK. A Comparative Study of Health Anxiety in Neurology and Psychiatry Settings. J Neurosci Rural Pract 2020; 11:125-129. [PMID: 32140015 PMCID: PMC7055604 DOI: 10.1055/s-0039-3399395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives
Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates.
Participants and Methods
This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12.
Results
The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings.
Conclusion
Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.
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Affiliation(s)
- Lakshmi Prabha
- Department of Psychiatry, Sri Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sundarnag Ganjekar
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vivek Gupta
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Geetha Desai
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Sutar R, Desai G, Varambally S, Gangadhar BN. An exploratory study of factors influencing acceptance of yoga therapy in somatoform disorder. Asian J Psychiatr 2020; 49:101630. [PMID: 30773350 DOI: 10.1016/j.ajp.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Roshan Sutar
- Department of Psychiatry, All Indian Institute of Medical Sciences, Bhopal.
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Mealth and Neuro Sciences, Bangalore
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Mealth and Neuro Sciences, Bangalore
| | - B N Gangadhar
- Department of Psychiatry, National Institute of Mental Mealth and Neuro Sciences, Bangalore
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Abstract
BACKGROUND Identifying patient perspectives about recovery may help the service providers to enhance active participation of patients in their recovery. AIM This study aimed to explore patients' perspectives about factors affecting recovery from schizophrenia. METHODS A semi-structured interview schedule was used to explore the perceptions of 18 patients diagnosed with schizophrenia. The interviews were recorded, transcribed and analysed. Codes were identified and similar codes were grouped together and main themes were identified. RESULTS Nine main themes on facilitators and barriers of recovery from schizophrenia were derived. CONCLUSION Deeper understanding of patients' perspectives of recovery from schizophrenia can help mental health professionals to plan appropriate recovery-oriented services.
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Affiliation(s)
| | - Diksy Jose
- Department of Nursing, Govt. Mental Health Centre, Thrissur, India
| | - Geetha Desai
- Department of Psychiatry, NIMHANS, Bangalore, India
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Nanjundaswamy MH, Shiva L, Desai G, Ganjekar S, Kishore T, Ram U, Satyanarayana V, Thippeswamy H, Chandra PS. COVID-19-related anxiety and concerns expressed by pregnant and postpartum women-a survey among obstetricians. Arch Womens Ment Health 2020; 23:787-790. [PMID: 32839898 PMCID: PMC7445074 DOI: 10.1007/s00737-020-01060-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022]
Abstract
This paper from India describes anxieties that pregnant and postpartum women reported to obstetricians during the COVID-19 pandemic. Of the 118 obstetricians who responded to an online survey, most had been contacted for concerns about hospital visits (72.65%), methods of protection (60.17%), the safety of the infant (52.14%), anxieties related to social media messages (40.68%) and contracting the infection (39.83%). Obstetricians felt the need for resources such as videos, websites and counselling skills to handle COVID-related anxiety among perinatal women.
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Affiliation(s)
- Madhuri H. Nanjundaswamy
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029 India
| | - Lakshmi Shiva
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029 India
| | - Geetha Desai
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029 India
| | - Sundarnag Ganjekar
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029 India
| | - Thomas Kishore
- grid.416861.c0000 0001 1516 2246Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029 India
| | - Uma Ram
- grid.502911.eConsultant Obstetrician, Seethapathy Clinic & Hospital, 128 Royapettah High Road, Chennai, India
| | - Veena Satyanarayana
- grid.416861.c0000 0001 1516 2246Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029 India
| | - Harish Thippeswamy
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029 India
| | - Prabha S. Chandra
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029 India
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Jaisoorya TS, Desai G, Nair BS, Rani A, Menon PG, Thennarasu K. Association of Childhood Attention Deficit Hyperactivity Disorder Symptoms with Academic and Psychopathological Outcomes in Indian College Students: a Retrospective Survey. East Asian Arch Psychiatry 2019; 29:124-128. [PMID: 31871309 DOI: 10.12809/eaap1771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. METHODS A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. RESULTS Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. CONCLUSIONS Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.
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Affiliation(s)
- T S Jaisoorya
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - G Desai
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - B S Nair
- Department of Psychiatry, Government Medical College, Ernakulam, Kerala, India
| | - A Rani
- Department of Psychiatry, Government Medical College, Ernakulam, Kerala, India
| | - P G Menon
- Department of Psychiatry, Government Medical College, Ernakulam, Kerala, India
| | - K Thennarasu
- National Institute of Mental Health and Neurosciences, Bangalore, India
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Murthy MKS, Kapanee ARM, Desai G, Chaturvedi SK. Exploring the knowledge and attitude of public about mental health problems: A pilot intervention for effective mental health promotion. J Educ Health Promot 2019; 8:177. [PMID: 31867362 PMCID: PMC6796309 DOI: 10.4103/jehp.jehp_137_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT The knowledge about mental health problems among the general public is comparatively quite low. The pilot study was conducted with an aim to increase the knowledge of the day-to-day mental health problems which people can have among the mass. AIMS The aims of this study are (1) to assess the knowledge and attitude about mental health problems of the selected sample and (2) to build the capacity in providing first aid for mental health to the selected sample through training. SETTINGS AND DESIGN A cross-sectional study was used in assessing the knowledge and skills of the participants of the first aid for mental health problems. It was conducted in the institute itself. SUBJECTS AND METHODS A total of 89 participants were taken to participate in the cross-sectional study. Using a semi-structured self-administered questionnaire, a brief training, and a feedback form, capacity building for first aid for mental health problems was provided. STATISTICAL ANALYSIS USED The questionnaires were analyzed using descriptive statistics. RESULTS The capacity building program for first aid for mental health problems appears to be effective in improving the knowledge and attitude with regard to the mental health problems. The findings from the program indicated lack of knowledge in understanding of mental health, knowledge of causation, and treatment of mental health problems. Feedback of the training program indicated that it improved the ability of the participants in recognizing persons undergoing mental health problems and brought about a change in their beliefs about mental health, attitudes, and need for prompt referral. CONCLUSIONS The program was successful in increasing the confidence of the participants in providing help to someone with a mental health problem and referring to appropriate mental health professional. This shows that there is an immediate need for empowering general public with knowledge and skills to provide support to people with mental health problems.
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Affiliation(s)
- Meena Kolar Sridara Murthy
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Aruna Rose Mary Kapanee
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Santosh Kumar Chaturvedi
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Abstract
The presentations of psychosocial distress and cultural conflicts are often bodily symptoms, especially in traditional societies and village backgrounds. These might not meet the criteria of the current psychiatric diagnostic systems. Sociocultural milieu contributes to the unique presentations of the stress in the form of idioms of distress. The latter are alternative modes of expressing distress and indicate manifestations of distress in relation to personal and cultural meaning. Health professionals often consider these as hysterical, functional or having functional overlays, and abnormal illness behaviors. Management of idioms of distress would need cultural competence and sensitivity. This article highlights the common idioms of distress in India with specific focus on bodily symptoms.
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Affiliation(s)
- Geetha Desai
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Simiyon M, Chandra P, Desai G. An Experiential Account of Sexual Dysfunction Among Women with Schizophrenia: A Qualitative Study from India. Journal of Psychosexual Health 2019. [DOI: 10.1177/2631831819894773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims: The study aimed to gather the perspectives of women with schizophrenia who had sexual dysfunction (SD) and to assess their perceptions related to discussions about sexual concerns with mental health professionals (MHP). Settings: Female patients attending the outpatient department of a tertiary care university psychiatric hospital, who were diagnosed to have schizophrenia and in remission, were recruited and assessed for SD. Those who had SD and were willing to participate were interviewed for the qualitative study. Methods and Materials: A guided interview format was used to gather their narratives. Interviews were transcribed and translated from audio recordings on the same day. The analysis of transcript from 9 patients reached theoretical saturation. Analysis: The data were retrieved, coded, and systematically organized according to patterns and themes. The manual inductive coding method was used to arrive at the themes. Results: 4 themes were found for the question assessing their perspective regarding SD and 3 themes on their perspectives regarding the discussion with MHP. Many of them had misconceptions regarding their sexual lives and the relationship between sexuality and their illness. It was evident that hardly any MHP had ever inquired about their sexual functioning. Conclusion: This qualitative research on women with schizophrenia having SD gives us in-depth knowledge regarding their snags. Results of such studies will help the clinicians pay justifiable attention to these least spoken problems.
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Affiliation(s)
- Manjula Simiyon
- Department of Psychiatry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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