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Mamtani H, Pathak H, Sakhardande K, Gowda GS, Muliyala KP, Philip M, Moirangthem S, Reddi VSK, Varambally S. Suicide attempts in schizophrenia - A large retrospective cohort study from a tertiary care psychiatry centre in India. Asian J Psychiatr 2024; 96:104053. [PMID: 38678797 DOI: 10.1016/j.ajp.2024.104053] [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: 10/11/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
The extent of variability in identified risk factors for suicide attempts (SA) in schizophrenia limits their generalization. This study aimed to identify the rates and associated correlates of SA in schizophrenia by reviewing a large cohort (n=500). Nearly one-fourth had a history of SA, which was independently associated with a family history of SA, more inpatient admissions, and better long-term treatment response. These findings highlight the complex interaction between biological factors influencing SA and illness determinants in schizophrenia. Furthermore, they reinforce the need for future research to unravel the association between suicide vulnerability and the pathophysiology of schizophrenia to attenuate morbidity and mortality associated with the same.
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Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Kasturi Sakhardande
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | | | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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Vajawat B, Suhas S, Moirangthem S, Kumar CN, Varghese M, Gururaj G, Benegal V, Rao GN. Bipolar affective disorder in India: A multi-site population-based cross-sectional study. Indian J Psychiatry 2023; 65:1230-1237. [PMID: 38298870 PMCID: PMC10826869 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_838_23] [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: 03/26/2022] [Revised: 09/18/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Bipolar Affective Disorder (BPAD) merits careful consideration within the medical and healthcare communities, researchers, and policymakers. This is due to its substantial disability burden, elevated prevalence of co-morbidities, heightened lifetime risk of suicidality, and a significant treatment gap. This article focuses on the lifetime and current prevalence, correlates, co-morbidities, associated disabilities, socio-economic impact, and treatment gap for BPAD in the adult population of the National Mental Health Survey (NMHS) 2016. Materials and Methods The NMHS 2016 was a nationally representative study conducted across 12 Indian states between 2014 and 2016. A multi-stage, stratified, random cluster sampling technique based on probability proportionate to size at each stage was used. The diagnosis of BPAD was based on Mini-International Neuropsychiatric Interview 6.0.0. Sheehan's Disability Scale was used to assess the disability. Results A total of 34,802 adults were interviewed. The overall weighted prevalence of BPAD was 0.3% [95% confidence interval (CI): 0.29-0.31] for current and 0.5% (95% CI: 0.49-0.51) for lifetime diagnosis. Male gender [odds ratio (OR) 1.56] and residence in urban metropolitans (OR 2.43) had a significantly higher risk of a lifetime diagnosis of BPAD. Substantial cross-sectional co-morbidities were noted as per MINI 6.0.0 with the diagnosis of current BPAD such as tobacco use disorder (33.3%), other substance use disorders (14.6%), and anxiety disorders (10.4%). Two-thirds of persons with current BPAD reported disability of varying severity at work (63%), social (59.3%), and family life (63%). The treatment gap for current BPAD was 70.4%. Conclusion Most individuals with current BPAD reported moderate-severe disability. There were substantial co-morbidities and a large treatment gap. These warrant concentrated efforts from policymakers in devising effective strategies.
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Affiliation(s)
- Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Vajawat B, Kumar CN, Hegde P, Moirangthem S, Basavaraju V, Prathyusha V, Bhaskarapillai B, Math SB, Murthy P. Clinical Profile, Course and Outcomes of Male Inpatients with Mental Illness Charged with Homicide: A Chart Review from an Indian Tertiary Care Hospital. Indian J Psychol Med 2023; 45:405-410. [PMID: 37483583 PMCID: PMC10357911 DOI: 10.1177/02537176221127141] [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: 07/25/2023] Open
Abstract
Background The relationship between imprisonment and mental illness is bidirectional. The clinical outcomes of prisoners with mental illness have not been widely studied, especially in developing countries. This study was conducted to assess the same among male inpatients under judicial custody with charges of homicide. Methods A retrospective chart review of male forensic ward inpatients admitted between January 1, 2003, and December 31, 2016, was conducted. Diagnosis in the files was based on the International Classification of Diseases (ICD)-10 criteria. The Clinical and Global Improvement-Severity (CGI-S) scale was used to measure the severity of illness. Mean CGI-S assessment was carried out at baseline, end of 1 year, 5 years, and 15 years. The data were analyzed using descriptive statistics, Friedman's test, and Dunn's post hoc test. Results Schizophrenia spectrum disorders and other psychotic disorders, mood disorders, and alcohol use disorders were diagnosed in 62(49.6%), 22(17.6%), and 44(35.2%) subjects, respectively. Forty-one (32.8%) subjects had at least one readmission. The average CGI-S score for the total subjects was 5 (markedly ill) at baseline and 2 (borderline ill) at the end of their latest contact with the tertiary care hospital. For the 34 subjects (27.2%) who had follow-up information of 15 years, the average CGI-S score was 1 (normal, not at all ill) at the end of 15 years (P < 0.001). Conclusion Clinical outcomes of prisoners with mental illness seem promising, subject to the seamless availability of services. Studies from other parts of the country are required for a more systematic understanding of the requirements of care.
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Affiliation(s)
- Bhavika Vajawat
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Prakyath Hegde
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vasuki Prathyusha
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Mohan V, Parekh P, Lukose A, Moirangthem S, Saini J, Schretlen DJ, John JP. Patterns of Impaired Neurocognitive Performance on the Global Neuropsychological Assessment, and Their Brain Structural Correlates in Recent-onset and Chronic Schizophrenia. Clin Psychopharmacol Neurosci 2023; 21:340-358. [PMID: 37119227 PMCID: PMC10157005 DOI: 10.9758/cpn.2023.21.2.340] [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] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 05/01/2023]
Abstract
Objective Schizophrenia is associated with impairment in multiple cognitive domains. There is a paucity of research on the effect of prolonged illness duration (≥ 15 years) on cognitive performance along multiple domains. In this pilot study, we used the Global Neuropsychological Assessment (GNA), a brief cognitive battery, to explore the patterns of cognitive impairment in recent-onset (≤ 2 years) compared to chronic schizophrenia (≥ 15 years), and correlate cognitive performance with brain morphometry in patients and healthy adults. Methods We assessed cognitive performance in patients with recent-onset (n = 17, illness duration ≤ 2 years) and chronic schizophrenia (n = 14, duration ≥ 15 years), and healthy adults (n = 16) using the GNA and examined correlations between cognitive scores and gray matter volumes computed from T1-weighted magnetic resonance imaging images. Results We observed cognitive deficits affecting multiple domains in the schizophrenia samples. Selectively greater impairment of perceptual comparison speed was found in adults with chronic schizophrenia (p = 0.009, η2partial = 0.25). In the full sample (n = 47), perceptual comparison speed correlated significantly with gray matter volumes in the anterior and medial temporal lobes (TFCE, FWE p < 0.01). Conclusion Along with generalized deficit across multiple cognitive domains, selectively greater impairment of perceptual comparison speed appears to characterize chronic schizophrenia. This pattern might indicate an accelerated or premature cognitive aging. Anterior-medial temporal gray matter volumes especially of the left hemisphere might underlie the impairment noted in this domain in schizophrenia.
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Affiliation(s)
- Vineeth Mohan
- Multimodal Brain Image Analysis Laboratory (MBIAL), Bangalore, India
- Department of Clinical Neurosciences, Bangalore, India
| | - Pravesh Parekh
- Multimodal Brain Image Analysis Laboratory (MBIAL), Bangalore, India
- ADBS Neuroimaging Centre (ANC), Bangalore, India
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ammu Lukose
- Multimodal Brain Image Analysis Laboratory (MBIAL), Bangalore, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - David J. Schretlen
- Department of Psychiatry and Behavioral Sciences, MD, USA
- Russel M. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P. John
- Multimodal Brain Image Analysis Laboratory (MBIAL), Bangalore, India
- ADBS Neuroimaging Centre (ANC), Bangalore, India
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Ramu PS, Gowda GS, Moirangthem S, Kumar CN, Yadav R, Srinivas D, Bhaskarapillai B, Math SB. Fitness to re-join job: Neuropsychiatric perspective. J Neurosci Rural Pract 2023; 14:320-326. [PMID: 37181179 PMCID: PMC10174145 DOI: 10.25259/jnrp_78_2022] [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] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives Evaluating "Fitness to Re-join Job" and certification in persons with Neuro-Psychiatric Disorders is an indispensable professional responsibility. However, there is little documented guidance on clinically approaching this particular issue. This study aimed to study the sociodemographic, clinical, and employment profile of patients who sought fitness to re-join their job from the tertiary neuropsychiatric center. Materials and Methods This study was carried out at the National Institute of Mental Health and Neurosciences in Bengaluru, India. A retrospective chart review was adapted for the purpose. One hundred and two case files referred to medical board for fitness to rejoin the duty were reviewed from January 2013 to December 2015. Apart from the descriptive statistics, the Chi-square test or Fisher exact test was used to test the association between categorical variables. Results Patients' mean (standard deviation) age was 40.1 (10.1) years; 85.3% were married, and 91.2% were male. Common reasons for seeking "fitness certification" were work absenteeism (46.1%), illness affecting the work (27.4%), and varied reasons (28.4%). The presence of neurological disorders, sensory-motor deficits, cognitive decline, brain damage/insult, poor drug compliance, irregular follow-ups, and poor or partial treatment response were associated with an unfitness to rejoin the job. Conclusion This study shows that work absenteeism and the impact of illness on work are common reasons for referral. Irreversible neurobehavioural problems and deficits impacting work are common reasons for unfitness to rejoin the job. There is a need for a systematic schedule to assess the fitness for the job in patients with neuropsychiatric disorders.
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Affiliation(s)
- Praveen Shivalli Ramu
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neuro Surgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Hegde PR, Gowda GS, Vajawat B, Basavaraju V, Moirangthem S, Naveen Kumar C, Bada Math S. Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study. Int J Soc Psychiatry 2023; 69:28-37. [PMID: 34961385 DOI: 10.1177/00207640211065675] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India. AIMS This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal. METHOD This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices. RESULTS A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading (n = 105, 35.0%), lying (n = 10, 3.3%), and threatening (n = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37-16.46), absent insight (OR 10.0; CI 2.01-47.56), and poor adherence to medication (OR 4.75; CI 1.31-16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care (Z = -4.37, p < .01), interpersonal (Z = -7.61, p < .01), work (Z = -5.9, p < .01), family functioning (Z = -7.82, p < .01) difficult behavior (Z = -8.27, p < .01), and dependency (Z = -6.34, p < .01) in persons with SMI with use of CoAdM. CONCLUSIONS CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.
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Affiliation(s)
- Prakyath R Hegde
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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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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Sukumaran SK, Paul P, Guttal V, Holla B, Vemula A, Bhatt H, Bisht P, Mathew K, Nadella RK, Varghese AM, K V, Purushottam M, Jain S, Sud R, Viswanath B, Viswanath B, Rao NP, Narayanaswamy JC, Sivakumar PT, Kandasamy A, Kesavan M, Mehta UM, Venkatasubramanian G, John JP, Purushottam M, Mukherjee O, Mehta B, Kandavel T, Binukumar B, Saini J, Jayarajan D, Shyamsundar A, Moirangthem S, Vijay Kumar KG, Mahadevan J, Holla B, Thirthalli J, Chandra PS, Gangadhar BN, Murthy P, Panicker MM, Bhalla US, Chattarji S, Benegal V, Varghese M, Reddy JYC, Padinjat R, Rao M, Jain S. Abnormalities in migration of neural precursor cells in familial bipolar disorder. Dis Model Mech 2022; 15:277960. [PMID: 36239094 PMCID: PMC9612872 DOI: 10.1242/dmm.049526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Cellular migration is a ubiquitous feature that brings brain cells into appropriate spatial relationships over time; and it helps in the formation of a functional brain. We studied the migration patterns of induced pluripotent stem cell-derived neural precursor cells (NPCs) from individuals with familial bipolar disorder (BD) in comparison with healthy controls. The BD patients also had morphological brain abnormalities evident on magnetic resonance imaging. Time-lapse analysis of migrating cells was performed, through which we were able to identify several parameters that were abnormal in cellular migration, including the speed and directionality of NPCs. We also performed transcriptomic analysis to probe the mechanisms behind the aberrant cellular phenotype identified. Our analysis showed the downregulation of a network of genes, centering on EGF/ERBB proteins. The present findings indicate that collective, systemic dysregulation may produce the aberrant cellular phenotype, which could contribute to the functional and structural changes in the brain reported for bipolar disorder. This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Salil K Sukumaran
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pradip Paul
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vishwesha Guttal
- Centre for Ecological Sciences, Indian Institute of Science, Bangalore, India.,Centre for Biosystems and Bioengineering, Indian Institute of Science, Bangalore, India
| | - Bharath Holla
- Dept. of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alekhya Vemula
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harsimar Bhatt
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Piyush Bisht
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kezia Mathew
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi K Nadella
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anu Mary Varghese
- Dept. of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijayalakshmi K
- Dept. of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Meera Purushottam
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanjeev Jain
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Reeteka Sud
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Biju Viswanath
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Biju Viswanath
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | | | - John P John
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Meera Purushottam
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Odity Mukherjee
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), India
| | - Bhupesh Mehta
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - B Binukumar
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Jitender Saini
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Deepak Jayarajan
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - A Shyamsundar
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - K G Vijay Kumar
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Jayant Mahadevan
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Bharath Holla
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | - Sumantra Chattarji
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), India
| | - Vivek Benegal
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Mathew Varghese
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | - Mahendra Rao
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), India
| | - Sanjeev Jain
- National Institute of Mental Health and Neurosciences (NIMHANS), India
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Johnson ET, Eraly SG, Aandi Subramaniyam B, Muliyala KP, Moirangthem S, Reddi VSK, Jain S. Complexities of cooccurrence of catatonia and autoimmune thyroiditis in bipolar disorder: A case series and selective review. Brain Behav Immun Health 2022; 22:100440. [PMID: 36118271 PMCID: PMC9475125 DOI: 10.1016/j.bbih.2022.100440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022] Open
Abstract
In recent years the neurobiological underpinnings of catatonia have been an emerging area of interest. Catatonia is frequently encountered in mood disorders, neurological disorders and systemic illnesses. Furthermore, the manifestation of catatonia in autoimmune disorders such as NMDA receptor antibody encephalitis and thyroiditis reinforces its neuropsychiatric nature. Irrespective of cause benzodiazepines and electroconvulsive therapy remain the standard treatments for catatonia, although a proportion fail to respond to the same. This report describes three women with pre-existing bipolar disorder presenting in catatonia. Interestingly in all three, while benzodiazepines and electroconvulsive therapy failed, a dramatic resolution of catatonia with corticosteroids was noted following the detection of Hashimoto's thyroiditis. Hashimoto's encephalopathy presenting as catatonia has been reported, but our patients' profile differed in having had an a priory diagnosis of bipolar disorder. Given that both catatonia and thyroid dysfunction are frequently encountered in bipolar disorder, Hashimoto's encephalopathy as a potential cause for this concurrent manifestation in bipolar disorder may be overlooked. Therefore, it is essential to suspect Hashimoto's encephalopathy when catatonia manifests in bipolar disorder. A timely evaluation would be prudent as they may fail to respond to standard treatments for catatonia but respond remarkably to corticosteroids, saving much time and angst. Recent evidence implicates immune system dysfunction, with neuroinflammation and peripheral immune dysregulation contributing to the pathophysiology of bipolar disorder as well as catatonia. Findings from this study reaffirm the role of immune system dysfunction common to the etiopathogenesis of all these disorders, highlighting the complex interplay between catatonia, thyroiditis and bipolar disorder. Catatonia is common in bipolar disorder and also noted in autoimmune disorders. Thyroiditis in bipolar disorder may be overlooked due to frequent occurrence of thyroid dysfunction. Catatonia in bipolar disorder may result from Hashimoto's encephalopathy. Hashimoto's related catatonia in bipolar disorder may poorly respond to standard treatment. Autoimmune thyroiditis and catatonia highlight the immune dysfunction hypothesis of bipolar disorder.
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Chander KR, Moirangthem S, Patley R, Philip S, Varshney P, Basavaraju V, Parthasarathy R, Krishna PVM, Manjunatha N, Channaveerachari NK, Math SB. A camp approach of community psychiatry in India: Past, present, and the future. Ind Psychiatry J 2022; 31:191-196. [PMID: 36419705 PMCID: PMC9678157 DOI: 10.4103/ipj.ipj_195_21] [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: 09/08/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022] Open
Abstract
Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.
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Affiliation(s)
- K Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Mental Health, Government of Karnataka, Bengaluru, Karnataka, India
| | - P V Mohan Krishna
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Kadiveti S, Vajawat B, Kumar CN, Hegde PR, Moirangthem S, Math SB. Free legal aid in hospitals for persons with mental illness: Is it helpful? An Indian prospective study. Indian J Psychiatry 2022; 64:322-325. [PMID: 35859558 PMCID: PMC9290419 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_510_21] [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: 06/17/2021] [Revised: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Legislative backing exists to set up free legal aid clinics in psychiatric hospitals to provide legal assistance to their patients. AIMS This study aimed to assess the utility of a free legal aid clinic running inside a mental health establishment. METHODS In this prospective study, 71 subjects (chosen via convenience sampling) were recruited. Assessments were carried out at baseline and two months after intake. Legal needs and the legal outcomes were assessed. RESULTS Most of the legal issues were either family-related (50.7%) or civil issues (28.2%). A majority of patients (64.4%) had implemented the advice given at the clinic. Those who had implemented the advice had a better legal outcome, defined as either resolution of the legal issue or that the legal issue was in an active proceeding compared to those who had not implemented the advice (P = 0.007). CONCLUSION The provision of free legal aid services in mental health establishments would benefit patients.
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Affiliation(s)
- Sriharsha Kadiveti
- Department of Psychiatry, Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Victoria, Australia
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Prakyath R Hegde
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Mamtani H, Pathak H, Sakhardande KA, Gowda GS, Muliyala KP, Moirangthem S, Reddi VSK, Varambally S. Can peripheral brain-derived neurotrophic factor (BDNF) be a potential biomarker of suicide risk in schizophrenia? Schizophr Res 2022; 243:203-205. [PMID: 35398726 DOI: 10.1016/j.schres.2022.03.010] [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] [Received: 02/15/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kasturi Atmaram Sakhardande
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Venkata Senthil Kumar Reddi
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Moirangthem S, Laskar SK, Das A, Upadhyay S, Hazarika RA, Mahanta JD, Sangtam HM. Effect of incorporation of soy protein isolate and Inulin on quality characteristics and shelf-life of low–fat Duck meat sausages. Anim Biosci 2022; 35:1250-1257. [PMID: 35240023 PMCID: PMC9262725 DOI: 10.5713/ab.21.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
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Agrawal AK, Bagewadi V, Das S, Moirangthem S. Recycling of Semen: A Rare Phenomenon in Dhat Syndrome. Psychiatr Danub 2022; 34:313-314. [PMID: 35772147 DOI: 10.24869/psyd.2022.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Adesh Kumar Agrawal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, 19, New Kabini Hostel, Nimhans, Bengaluru-560029, India,
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Navin K, Mahadevan J, Jain R, Moirangthem S. A Psychiatric-COVID Unit: The National Institute of Mental Health and Neuro Sciences (NIMHANS) Experience. Indian J Psychol Med 2021; 43:252-256. [PMID: 34345102 PMCID: PMC8287385 DOI: 10.1177/02537176211006324] [Citation(s) in RCA: 3] [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: 11/29/2022] Open
Affiliation(s)
- Karthick Navin
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Richa Jain
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Malathesh BC, Kumar CN, Kandasamy A, Moirangthem S, Math SB, Murthy P. Legal, Social, and Occupational Problems in Persons with Alcohol Use Disorder: An Exploratory Study. Indian J Psychol Med 2021; 43:234-240. [PMID: 34345099 PMCID: PMC8287396 DOI: 10.1177/0253717620956466] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Very few studies have examined the extent and nature of legal, social, and occupational problems among persons who have SUDs. This study was aimed at studying the prevalence and patterns of the aforementioned problems among individuals with alcohol use disorders (AUDs) and their relationship with the quantity of alcohol consumed and other variables. METHODS We conducted a cross-sectional study of adult patients with a diagnosis of AUDs admitted to the deaddiction unit of a tertiary care facility in India, using a semistructured questionnaire prepared for this study. RESULTS The mean age (SD) of the 91 subjects (95.6% males) was 40.3 years (8.5). Majority of them (92.3%) had started alcohol consumption before the age of 25 years. Common problems reported were work absenteeism (83.5%), a major altercation with spouse (69.3%), assaulting someone while intoxicated (53.8%), and driving under the influence of alcohol (59.3%). Significant association was found between being unemployed and having a police complaint lodged against them (chi-square = 5.7, P = 0.01). Quantity of alcohol consumed per day was significantly more among those who had a history of work absenteeism (Z = 2.27, P = 0.01), major altercation with spouse (Z = 2.25, P = 0.02) and assaulted someone under intoxication (Z = 2.33, P = 0.02). CONCLUSION The quantity of alcohol consumed is significantly more in those who had several legal, social, and occupational problems when compared to those who did not have, highlighting the need for routine assessment of the aforementioned problems among patients of AUDs. Treatment of AUDs should be multidisciplinary, with targeted interventions tailored to the aforementioned problems. Doing so will go a long way in reducing the harm to patients and the community at large.
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Affiliation(s)
- Barikar C Malathesh
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Arun Kandasamy
- Center for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Forensic Psychiatry services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kulkarni KR, Shyam RPS, Bagewadi VI, Gowda GS, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study of collaborative telepsychiatric consultations for a rehabilitation centre managed by a primary healthcare centre. Indian J Med Res 2021; 152:417-422. [PMID: 33380707 PMCID: PMC8061593 DOI: 10.4103/ijmr.ijmr_676_18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background & objectives: Telepsychiatric methods can be used for the purpose of providing clinical care comparable to in-person treatment in various settings including rehabilitation. Previous evidence has shown that clinical outcomes for both are comparable. In view of challenges posed in the implementation of traditional psychiatric care in India, telepsychiatry offers an avenue to provide feasible, affordable and clinically useful psychiatric services. This study was conducted to examine the utility, feasibility and clinical effectiveness of providing collaborative telepsychiatric services with a primary care doctor for inpatients in a rehabilitation centre through a telepsychiatrist of estabilished psychiatry department in a tertiary care centre in south India in a collaborative care model with a primary care doctor. Methods: Patients at the rehabilitation centre attached to an urban primary healthcare centre received collaborative care using telepsychiatry for a period from January 2013 to December 2016. A retrospective review of their charts was performed and sociodemographic, clinical and treatment details were collected and analyzed. Results: The sample population (n=132) consisted of 75 per cent males, with a mean age of 43.8 ± 12.1 yr. Each patient received an average of 7.8 ± 4.9 live video-consultations. Initially, an antipsychotic was prescribed for 84.1 per cent (n=111) of patients. Fifty four patients (40.9%) had a partial response and 26 (19.7%) patients showed a good response. Interpretation & conclusions: The study sample represented the population of homeless persons with mental illness who are often brought to the rehabilitation centre. This study results demonstrated the successful implementation of inpatients collaborative telepsychiatry care model for assessment, follow up, investigation and treatment of patients through teleconsultation.
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Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R P S Shyam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harihara N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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18
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Gowda GS, Chithra NK, Moirangthem S, Kumar CN, Math SB. Homeless persons with mental illness and COVID pandemic: Collective efforts from India. Asian J Psychiatr 2020; 54:102268. [PMID: 32622032 PMCID: PMC7313514 DOI: 10.1016/j.ajp.2020.102268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/18/2022]
Abstract
COVID-19 pandemic had made an unprecedented impact worldwide. India has entered into a total lockdown by invoking the special provision of Epidemic Diseases Act of 1897 and Disaster Management Act, 2015. The complete lockdown policy has a direct and indirect impact on Homeless Persons with Mental Illness (HPMI) concerning shelter, basic needs and access to health care, besides the transmission of COVID infection. In this manuscript, we highlight the collective efforts undertaken by both the Government and Civil Society in providing care and protection to HPMI against COVID during the lockdown in India.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India.
| | - Nellai K Chithra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, India
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Someshwar A, Holla B, Pansari Agarwal P, Thomas A, Jose A, Joseph B, Raju B, Karle H, Muthukumaran M, Kodancha PG, Kumar P, Reddy PV, Kumar Nadella R, Naik ST, Mitra S, Mallappagiri S, Sreeraj VS, Balachander S, Ganesh S, Murthy P, Benegal V, Reddy JY, Jain S, Mahadevan J, Viswanath B, Narayanaswamy JC, Sivakumar PT, Kandasamy A, Kesavan M, Mehta UM, Venkatasubramanian G, John JP, Mukherjee O, Purushottam M, Kannan R, Mehta B, Kandavel T, Binukumar B, Saini J, Jayarajan D, Shyamsundar A, Moirangthem S, Vijay Kumar KG, Thirthalli J, Chandra PS, Gangadhar BN, Panicker MM, Bhalla US, Chattarji S, Varghese M, Raghu P, Rao M. Adverse childhood experiences in families with multiple members diagnosed to have psychiatric illnesses. Aust N Z J Psychiatry 2020; 54:1086-1094. [PMID: 32538179 DOI: 10.1177/0004867420931157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/05/2023]
Abstract
OBJECTIVE Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditions (multiplex families), identified as part of an ongoing longitudinal study. METHODS Our sample consisted of 509 individuals from 215 families. Of these, 268 were affected, i.e., diagnosed with bipolar disorder (n = 61), obsessive-compulsive disorder (n = 58), schizophrenia (n = 52), substance dependence (n = 59) or co-occurring diagnoses (n = 38), while 241 were at-risk first-degree relatives who were either unaffected (n = 210) or had other depressive or anxiety disorders (n = 31). All individuals were evaluated using the Adverse Childhood Experiences - International Questionnaire and total adverse childhood experiences exposure and severity scores were calculated. RESULTS It was seen that affected males, as a group, had the greatest adverse childhood experiences exposure and severity scores in our sample. A Cox mixed effects model fit by gender revealed that a higher total adverse childhood experiences severity score was associated with significantly increased risk for an earlier age of onset of psychiatric diagnoses in males. A similar model that evaluated the interaction of diagnosis revealed an earlier age of onset in obsessive-compulsive disorder and substance dependence, but not in schizophrenia and bipolar disorder. CONCLUSION Our study indicates that adverse childhood experiences were associated with an earlier onset of major psychiatric conditions in men and individuals diagnosed with obsessive-compulsive disorder and substance dependence. Ongoing longitudinal assessments in first-degree relatives from these families are expected to identify mechanisms underlying this relationship.
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Affiliation(s)
- Amala Someshwar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.,National Centre for Biological Sciences (NCBS), Bengaluru, India
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preeti Pansari Agarwal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anza Thomas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anand Jose
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Boban Joseph
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Birudu Raju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Hariprasad Karle
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - M Muthukumaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabhath G Kodancha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sanjay T Naik
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sayantanava Mitra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sreenivasulu Mallappagiri
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suhas Ganesh
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Janardhan Yc Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Ritish D, Dinakaran D, Chander R, Murugesan M, Ibrahim FA, Parthasarathy R, Pandey PK, Sharma MK, Pandian D, Manjunatha N, Reddi SK, Moirangthem S, Kumar CN, Suresh BM, Gangadhar BN. Mental health concerns in quarantined international air passengers during COVID-19 pandemic - An experiential account. Asian J Psychiatr 2020; 53:102364. [PMID: 32877856 PMCID: PMC7446664 DOI: 10.1016/j.ajp.2020.102364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 07/04/2020] [Accepted: 08/24/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Daniel Ritish
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Damodharan Dinakaran
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India.
| | - Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Manisha Murugesan
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Ferose Azeez Ibrahim
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Rajani Parthasarathy
- Mental Health, Department of Health and Family Welfare, Government of Karnataka, India
| | | | - Manoj Kumar Sharma
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Dhanasekara Pandian
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Senthil Kumar Reddi
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | | | - Bada Math Suresh
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, India
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Abstract
Access to mental health care has significant disparities due to treatment gap, more so particularly for the remotely residing, physically vulnerable, aging populations. Adoption of technology will enable more people to receive specialty care addressing distance, transportation and cost-related barriers to treatment engagement from the comfort of home. Telemedicine has been regarded as "electronic personal protective equipment" by reducing the number of physical contacts and risk contamination for patients during COVID-19 crisis. This review aimed to give a broad view of patients' perception of the use of telepsychiatry in terms of clinical outcome, cost-effectiveness, and solutions to address patients' challenges with the adoption of technology. Over the years, telepsychiatry, both in synchronous and asynchronous modalities, had shown to improve patients' adherence to treatment, follow-up rates, and clinical symptoms, overcome stigma and discrimination, and save cost expenses accessing health care with better satisfaction and usability outcomes. Its utility is widespread such as in delivering care emergency evaluation, crisis intervention, conducting neuropsychological assessments, psychotherapy, promoting lifestyle modification, enhancing self-efficacy, and overcoming patients' linguistic and cultural barriers to care. However, patients' privacy and confidentiality and psychiatrists' legal liability remain as matter of major concern in digital platform. To keep up with the pace of technology and patients' expectations, a more agile approach is essential to develop, improve, and evaluate telepsychiatric interventions.
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Affiliation(s)
- Shalini S Naik
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Tele Medicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Tele Medicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Philip S, Chandran D, Stezin A, Viswanathaiah GC, Gowda GS, Moirangthem S, Kumar CN, Math SB. EAT-PAD: Educating about psychiatric advance directives in India. Int J Soc Psychiatry 2019; 65:207-216. [PMID: 30945582 DOI: 10.1177/0020764019834591] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND With India enacting the Mental Health Care Act (MHCA; No. 10 of 2017a), Psychiatric Advance Directives (PADs) have been legalised and have become binding orders for psychiatrists treating patients. There is a paucity of research into acceptability of PADs in Indian mental health care, likely due to a lack of awareness. There are no educational measures about PADs provided for in this Act. Facilitators and facilitation methods have not been elaborated upon as well. AIM The aim of this study is (a) to develop/evaluate the effectiveness of a structured Education-cum-Assessment Tool (EAT) in providing information regarding PADs and (b) to evaluate modes of facilitation required by patients to complete PADs. METHODS A tool was developed as per provisions regarding PADs in the Mental Health Care Bill of 2013. This tool was administered to patients ( n = 100), purposively sampled from the adult psychiatry review out-patient department (OPD). Patients were evaluated on retention of information, completion of PADs, modes of facilitation and time taken to write one. RESULTS Mean years of education was 8.28 (±5.74) years and mean duration of illness was 8.30 (±7.04) years. In all, 65% had Below-Poverty Line (BPL) status. All participants completed valid PADs in an average of 15 minutes. About 93% required facilitation via assistance in writing and reminding. The mean EAT scores implied above 70% retention but did not relate to types of facilitation. CONCLUSIONS EAT scores can be used as an approximate measure of the patient's ability to understand and retain information which is a part of decisional capacity. Types of facilitation can help in understanding patient's ability to communicate their choices. Service providers may find EAT a time-effective tool for uniformly educating service users regarding PADs and indirectly assessing competence.
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Affiliation(s)
- Sharad Philip
- 1 Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhanya Chandran
- 2 Neuropsychology Unit, Department of Clinical Psychology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Albert Stezin
- 3 Department of Clinical Neurosciences, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Geetha C Viswanathaiah
- 4 Center for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S Gowda
- 1 Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- 1 Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- 1 Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- 1 Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Abstract
With the ratification of the landmark United Nations Convention on Rights of Persons with Disabilities by India, it was imperative to revamp the mental health-care legislation, among other changes. Most notably, a presumption of mental capacity has been introduced, which means a paradigm shift in the client and provider relationship. The Mental Healthcare Act, 2017 empowers all persons to make advance directives (AD) and nominate representatives for shared decision-making. Psychiatric ADs (PADs) also seem to improve the information exchange between the care provider and the service user. PADs may also be used as a vehicle of consent to future treatments. While drafting the PAD, the drafter must also plan how such directed care would be financed. Insurance companies have not been mandated to comply with ADs. In the eventuality that the drafter's family refuse support for treatment specified in the PAD, the drafter would be left holding an unimplementable PAD. The AD saw its origins in the care of the terminally ill and decades later came to be utilized in mental health care. After nearly three decades of use in developed countries, evidence at best remains mixed or inconclusive. This review focuses on the AD from the Indian perspective.
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Affiliation(s)
- Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Subhashini K Rangarajan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mahesh R Gowda
- Department of Psychiatry, Spandana Health Care, Bengaluru, Karnataka, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Abstract
India's ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) necessitated the need for a rights-based, biopsychosocial model of disability, which was endorsed in the Rights of Persons with Disabilities (RPwD) Act, 2016. This article examines the Act, its rules, and guidelines provided by the Government of India, from a mental health perspective, and compares it to its predecessor, the Persons with Disabilities (PwD) Act, 1995. The RPwD Act provides clearer definitions of various constructs, a greater focus on rights of PwD, and guidelines for assessment and certification of disabilities. There is, however, an underemphasis on mental illnesses in the reservation and legal decision making, and a move toward centralizing the process of disability certification. Also, there is a lack of clarity about screening instruments to be used, resource allocation to implement the provisions, and the guidelines for inclusive education. This article suggests recommendations that could strengthen some of these provisions.
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Affiliation(s)
- Abhilash Balakrishnan
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Karishma Kulkarni
- Department of Psychiatry, North Western Mental Health, Parkville, Melbourne, Australia
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Gowda GS, Kulkarni K, Bagewadi V, Rps S, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study on collaborative telepsychiatric consultations to outpatients of district hospitals of Karnataka, India. Asian J Psychiatr 2018; 37:161-166. [PMID: 30278379 DOI: 10.1016/j.ajp.2018.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 06/13/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Indian National Mental Health Survey (NMHS) of 2015-2016 has estimated 13.7% lifetime and 10.6% point prevalence for mental illnesses. It has identified that the treatment gap for mental illnesses ranges between 70% and 92%. Tele-Psychiatric consultations could be an alternative and innovative approach to bridge this gap in low resource settings. AIMS To study the sociodemographic and clinical profiles of patients who have received collaborative Tele-Psychiatric consultations across district hospitals in Karnataka, India. METHODOLOGY We performed a retrospective review of case files of patients who have received collaborative Tele-Psychiatric consultations from January 2013 to June 2017 through video-conferencing. A total of 139 consultations were provided to patients in the state of Karnataka. RESULTS The mean age of the sample is 31 (±15.5) years. 61.8% were male and 79.8% were aged more than 18 years. In total, 25.9% of them had schizophrenia and other psychotic disorders, 14.4% had mental retardation, 13.7% had a mood disorder and 14.4% had a substance use disorder. 67.6% of patients had been advised pharmacotherapy, 7.9% had been advised rehabilitation along with pharmacotherapy and 24.4% were advised further evaluation of illness and inpatient care at a higher centre. CONCLUSION Collaborative tele-psychiatric consultations to district hospitals from an academic tertiary care hospital can be feasible and are likely to benefit patients from rural areas. There is a need for more studies to elucidate their acceptability by patients, caregivers and professionals.
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Affiliation(s)
- Guru S Gowda
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Karishma Kulkarni
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Virupaksha Bagewadi
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Shyam Rps
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Harihara N Shashidhara
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Vinay Basavaraju
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India.
| | - Sydney Moirangthem
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - C Naveen Kumar
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Suresh Bada Math
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
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Viswanath B, Rao NP, Narayanaswamy JC, Sivakumar PT, Kandasamy A, Kesavan M, Mehta UM, Venkatasubramanian G, John JP, Mukherjee O, Purushottam M, Kannan R, Mehta B, Kandavel T, Binukumar B, Saini J, Jayarajan D, Shyamsundar A, Moirangthem S, Vijay Kumar KG, Thirthalli J, Chandra PS, Gangadhar BN, Murthy P, Panicker MM, Bhalla US, Chattarji S, Benegal V, Varghese M, Reddy JYC, Raghu P, Rao M, Jain S. Discovery biology of neuropsychiatric syndromes (DBNS): a center for integrating clinical medicine and basic science. BMC Psychiatry 2018; 18:106. [PMID: 29669557 PMCID: PMC5907468 DOI: 10.1186/s12888-018-1674-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/21/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is emerging evidence that there are shared genetic, environmental and developmental risk factors in psychiatry, that cut across traditional diagnostic boundaries. With this background, the Discovery biology of neuropsychiatric syndromes (DBNS) proposes to recruit patients from five different syndromes (schizophrenia, bipolar disorder, obsessive compulsive disorder, Alzheimer's dementia and substance use disorders), identify those with multiple affected relatives, and invite these families to participate in this study. The families will be assessed: 1) To compare neuro-endophenotype measures between patients, first degree relatives (FDR) and healthy controls., 2) To identify cellular phenotypes which differentiate the groups., 3) To examine the longitudinal course of neuro-endophenotype measures., 4) To identify measures which correlate with outcome, and 5) To create a unified digital database and biorepository. METHODS The identification of the index participants will occur at well-established specialty clinics. The selected individuals will have a strong family history (with at least another affected FDR) of mental illness. We will also recruit healthy controls without family history of such illness. All recruited individuals (N = 4500) will undergo brief clinical assessments and a blood sample will be drawn for isolation of DNA and peripheral blood mononuclear cells (PBMCs). From among this set, a subset of 1500 individuals (300 families and 300 controls) will be assessed on several additional assessments [detailed clinical assessments, endophenotype measures (neuroimaging- structural and functional, neuropsychology, psychophysics-electroencephalography, functional near infrared spectroscopy, eye movement tracking)], with the intention of conducting repeated measurements every alternate year. PBMCs from this set will be used to generate lymphoblastoid cell lines, and a subset of these would be converted to induced pluripotent stem cell lines and also undergo whole exome sequencing. DISCUSSION We hope to identify unique and overlapping brain endophenotypes for major psychiatric syndromes. In a proportion of subjects, we expect these neuro-endophenotypes to progress over time and to predict treatment outcome. Similarly, cellular assays could differentiate cell lines derived from such groups. The repository of biomaterials as well as digital datasets of clinical parameters, will serve as a valuable resource for the broader scientific community who wish to address research questions in the area.
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Affiliation(s)
- Biju Viswanath
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Naren P. Rao
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Muralidharan Kesavan
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | | | - John P. John
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Odity Mukherjee
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), Bangalore, India
| | - Meera Purushottam
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Ramakrishnan Kannan
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Bhupesh Mehta
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Thennarasu Kandavel
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - B. Binukumar
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Jitender Saini
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Deepak Jayarajan
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - A. Shyamsundar
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sydney Moirangthem
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - K. G. Vijay Kumar
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Jagadisha Thirthalli
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Prabha S. Chandra
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Mitradas M. Panicker
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (NCBS-TIFR), Bangalore, India
| | - Upinder S. Bhalla
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (NCBS-TIFR), Bangalore, India
| | - Sumantra Chattarji
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), Bangalore, India
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (NCBS-TIFR), Bangalore, India
| | - Vivek Benegal
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Mathew Varghese
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Padinjat Raghu
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (NCBS-TIFR), Bangalore, India
| | - Mahendra Rao
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), Bangalore, India
| | - Sanjeev Jain
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Singh G, Manjunatha N, Rao S, Shashidhara HN, Moirangthem S, Madegowda RK, Binukumar B, Varghese M. Use of Mobile Phone Technology to Improve follow-up at a Community Mental Health Clinic: A Randomized Control Trial. Indian J Psychol Med 2017; 39:276-280. [PMID: 28615760 PMCID: PMC5461836 DOI: 10.4103/0253-7176.207325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/25/2022] Open
Abstract
BACKGROUND Mobile phone technology is being used worldwide to improve follow-ups in health care. AIM Aim of the study is to evaluate whether the use of mobile technology will improve or not the follow-up of Indian patients from a community mental health center. MATERIALS AND METHODS Patients or caregivers having mobile phones and consenting for study were enrolled, and sociodemographic and clinical details of patients were taken. Participants were randomized into two groups (short message service [SMS] vs. non-SMS group). At first intervention level, a SMS was sent to SMS group (not in non-SMS group) 1 day before their appointment. At second-level intervention (voice call level), patients from both groups who missed their first appointment were given a voice call requesting them to come for follow-up, and the reasons for first missed appointments (MA) were also elicited. The effect of these two intervention levels (first SMS for SMS group and next voice calls for both groups) on follow-up was evaluated. RESULTS A total of 214 patients were enrolled in the study. At first SMS intervention level of SMS group (n = 106), 62.26% of participants reached appointment-on-time (RA), while in the non-SMS/as usual group (n = 108), 45.37% of patients RA. The difference of these groups is statistically significant. At second-level intervention (voice call), 66 of 88 (another 15 were unable to contact) were came for follow-up consultation within 2 days of MA. Distance and diagnosis of alcohol dependence were significantly associated with MA. Social reasons were most common reasons for first MA. CONCLUSION The use of mobile phone technology in an outpatient community psychiatric clinic improved follow-up significantly.
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Affiliation(s)
- Gaurav Singh
- Department of Psychiatry, K.D. Medical College Hospital and Research Center, Mathura, Uttar Pradesh, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sabina Rao
- Sakra Hospital, Bengaluru, Karnataka, India
| | - H N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajendra K Madegowda
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B Binukumar
- Biostatistics, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Moirangthem S, Rao S, Kumar CN, Narayana M, Raviprakash N, Math SB. Telepsychiatry as an Economically Better Model for Reaching the Unreached: A Retrospective Report from South India. Indian J Psychol Med 2017; 39:271-275. [PMID: 28615759 PMCID: PMC5461835 DOI: 10.4103/ijpsym.ijpsym_441_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/18/2023] Open
Abstract
AIM In a resource-poor country such as India, telepsychiatry could be an economical method to expand health-care services. This study was planned to compare the costing and feasibility of three different service delivery models. The end user was a state-funded long-stay Rehabilitation Center (RC) for the homeless. METHODOLOGY Model A comprised patients going to a tertiary care center for clinical care, Model B was community outreach service, and Model C comprised telepsychiatry services. The costing included expenses incurred by the health system to complete a single consultation for a patient on an outpatient basis. It specifically excluded the cost borne by the care-receiver. No patients were interviewed for the study. RESULTS The RC had 736 inmates, of which 341 had mental illness of very long duration. On comparing the costing, Model A costed 6047.5 INR (100$), Model B costed 577.1 INR (9.1$), and Model C costed 137.2 INR (2.2$). Model C was found fifty times more economical when compared to Model A and four times more economical when compared to Model B. CONCLUSION Telepsychiatry services connecting tertiary center and a primary health-care center have potential to be an economical model of service delivery compared to other traditional ones. This resource needs to be tapped in a better fashion to reach the unreached.
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Affiliation(s)
| | - Sabina Rao
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Affiliation(s)
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bengaluru 560 029, Karnataka, India
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Math SB, Moirangthem S, Kumar NC, Nirmala MC. Ethical and legal issues in cross-system practice in India: Past, present and future. Natl Med J India 2015; 28:295-299. [PMID: 27294458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Recent changes in policies allowing practitioners of Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) to integrate into the mainstream of healthcare and also allowing practitioners of Ayurveda and Homoeopathy to perform medical termination of pregnancy (MTP) under the proposed amendment to the MTP bill have brought crosssystem practice into the limelight. We evaluate cross-system practice from its legal and ethical perspectives. Across judgments, the judiciary has held that cross-system practice is a form of medical negligence; however, it is permitted only in those states where the concerned governments have authorized it by a general or special order. Further, though a state government may authorize an alternative medicine doctor to prescribe allopathic medicines (or vice versa), it does not condone the prescription of wrong medicines or wrong diagnosis. Courts have also stated that prescribing allopathic medicines and misrepresenting these as traditional medicines is an unfair trade practice and not explaining the side-effects of a prescribed allopathic medicine amounts to medical negligence. Finally, the Supreme Court has cautioned that employing traditional medical practitioners who do not possess the required skill and competence to give allopathic treatment in hospitals and to let an emergency patient be treated by them is gross negligence. In the event of an unwanted outcome, the responsibility is completely on the hospital authorities. Therefore, there is an urgent need to abolish cross-system practice, invest in healthcare, and bring radical changes in health legislations to make right to healthcare a reality.
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, Karnataka, India,
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, Karnataka, India
| | - Naveen C Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, Karnataka, India
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Abstract
Insanity defense is primarily used in criminal prosecutions. It is based on the assumption that at the time of the crime, the defendant was suffering from severe mental illness and therefore, was incapable of appreciating the nature of the crime and differentiating right from wrong behavior, hence making them not legally accountable for crime. Insanity defense is a legal concept, not a clinical one (medical one). This means that just suffering from a mental disorder is not sufficient to prove insanity. The defendant has the burden of proving the defense of insanity by a "preponderance of the evidence" which is similar to a civil case. It is hard to determine legal insanity, and even harder to successfully defend it in court. This article focuses on the recent Supreme Court decision on insanity defense and standards employed in Indian court. Researchers present a model for evaluating a defendant's mental status examination and briefly discuss the legal standards and procedures for the assessment of insanity defense evaluations. There is an urgent need to initiate formal graduation course, setup Forensic Psychiatric Training and Clinical Services Providing Centers across the country to increase the manpower resources and to provide fair and speedy trail.
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Institute of National Importance), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Institute of National Importance), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Institute of National Importance), Bengaluru, Karnataka, India
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Abstract
Disaster mental health is based on the principles of 'preventive medicine' This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six 'R's such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, Karnataka, India
| | | | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, Karnataka, India
| | - Naveen C. Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, Karnataka, India
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Abstract
Cross-system practice is widely prevalent in Indian settings. The recent policy decisions of the Government of India and the legalisation of cross-system practice in various states have brought this issue into the limelight once again. We aim to critically evaluate this issue from the philosophical, academic, and public health perspectives, as well as with reference to training. On the one hand, students of traditional Indian medicine are being introduced to allopathy without philosophical backing, practice based on the aetiological model and training in modern pharmacology. In addition, pharmaceutical industries are wooing AYUSH practitioners and their prescription patterns have already been "allopathised". As for the allopathic system, it is witnessing enormous scientific advances and growing increasingly complicated. The medicines are risky and also associated with many life-threatening side-effects. Meanwhile, the government is grappling with the humungous problem of ensuring health services for all. The government's intention is to expand the reach of health services by allowing cross-system practice, but the issue has much wider ramifications. The authors believe that before cross-system practice is allowed, there is a need for a comprehensive and deeper understanding of all the benefits and pitfalls of such as system. A few of these are discussed in this article. Specifically, we delve into the philosophical issues, syllabus and training, advances in medical technology, and larger public health perspectives. We end by suggesting a few steps that may help to improve public health in the country.
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Affiliation(s)
- Suresh Bada Math
- Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Lakkasandra, Bangalore, Karnataka 500 029, India,.
| | - Sydney Moirangthem
- Assistant Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Lakkasandra, Bangalore, Karnataka 500 029, India
| | - C Naveen Kumar
- Assistant Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Lakkasandra, Bangalore, Karnataka 500 029, India
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, Karnataka, India
| | - Naveen C Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, Karnataka, India
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