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Kumar, Channaveerachari Naveen, Prabhat Kumar Chand, Narayana Manjunatha, Suresh Bada Math, Harihara Nagabhushana Shashidhara, Vinay Basavaraju, Jagadisha Thirthalli, et al. "Impact Evaluation of VKN–NIMHANS–ECHO Model of Capacity Building for Mental Health and Addiction: Methodology of Two Randomized Controlled Trials." Indian Journal of Psychological Medicine 42, no. 6_suppl (December 2020): S80—S86. http://dx.doi.org/10.1177/0253717620969066.
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Background: Bridging the alarming treatment gap for mental disorders in India requires a monumental effort from all stakeholders. Harnessing digital technology is one of the potential ways to leapfrog many known barriers for capacity building. Aim and Context: The ongoing Virtual Knowledge Network (VKN)–National Institute of Mental Health and Neurosciences (NIMHANS)–Extension of Community Health Outcomes (ECHO) (VKN–NIMHANS–ECHO: hub and spokes model) model for skilled capacity building is a collaborative effort between NIMHANS and the University of New Mexico Health Sciences Centre, USA. This article aims to summarize the methodology of two randomized controlled trials funded by the Indian Council of Medical Research (ICMR) designed to evaluate the effectiveness of the VKN–NIMHANS–ECHO model of training as compared to training as usual (TAU). Methods: Both RCTs were conducted in Karnataka, a southern Indian state in which the DMHP operates in all districts. We compared the impact of the following two models of capacity building for the DMHP workforce (a) the VKN–NIMHANS–ECHO model and (b) the traditional method. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of these two trials. Trial 1 is to evaluate the “Effectiveness of addition of Virtual-NIMHANS–ECHO tele-mentoring model for skilled capacity building in providing quality care in alcohol use disorders by the existing staff of DMHP districts of Karnataka.” Hub for trial 1 was set up at NIMHANS and the spokes were psychiatrists and other mental health professionals headquartered in the district level office. Trial 2 assesses the implementation and evaluation of the NIMHANS–ECHO blended training program for the DMHP workforce in a rural south-Indian district of Karnataka state. The hub for trial 2 was set up in the district headquarter of Ramanagaram. Hub specialists are DMHP psychiatrists, whereas spokes are the non-doctor workforce (including auxiliary nurse midwives [ANMs] and accredited social health activists [ASHA] workers) medical officers of primary health centers. The location of the HubHub differs in these two studies. Both trials are funded by the ICMR, Government of India Discussion: Both these trials, though conceptually similar, have some operational differences which have been highlighted. If demonstrated to be effective, this model of telementoring can be generalized and widely merged into the Indian health care system, thus aiding in reducing the treatment gap for patients unable to access care.
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Sathur Raghuraman, Bharathram, Manamohan Nataraj, and Lakshmi Shiva. "Psychiatry trainee stressors in a postgraduate psychiatry training centre in India." BJPsych International 16, no. 03 (September 28, 2018): 53–55. http://dx.doi.org/10.1192/bji.2018.25.
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Stress and burnout are major issues affecting medical trainees, especially psychiatry trainees, throughout the world. Stress and burnout were studied using an online survey among psychiatry trainees of the National Institute of Mental Health and Neurosciences (NIMHANS) which is one of the oldest and largest training centers in India. Postgraduate training in academic institutions like NIMHANS, while offering excellent teaching experience, may impact the mental and physical health of trainees due to complex clinical challenges and academic pressure. Measures need to be taken to enhance trainee well-being by ensuring support from colleagues and seniors, allowing for an adequate work–life balance, introducing departmental level committees to address grievances and providing therapy and mentorship. Providing safe and non-stigmatizing spaces to seek help in workplace promotes whole-person growth and well being.
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Bairy, Bhavya K., Aurobind Ganesh, Sandeepa Kaur, Prabhat Kumar Chand, Channaveerachari Naveen Kumar, Narayana Manjunatha, Suresh Bada Math, Narendra Kumar Sinha, and Sanjeev Arora. "Capacity Building in Mental Health for Bihar: Overview of the 1-Year Blended Training Program for Nonspecialist Medical Officers." Journal of Neurosciences in Rural Practice 12, no. 02 (April 2021): 329–34. http://dx.doi.org/10.1055/s-0041-1722842.
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Abstract Objective The aim of this study is to give an experiential overview of a 1-year blended training program for nonspecialist medical officers (primary care doctors; PCDs) of Bihar State of India. The training program was aimed to enable PCDs identify, diagnose, and treat commonly presenting psychiatric disorders in primary care Methods PCDs had a brief onsite orientation program to psychiatric practice at National Institute of Mental Health and Neuro-Sciences (NIMHANS), followed by 10 months of online blended training. The online program followed the NIMHANS Virtual Knowledge- Extension for Community Healthcare Outcomes (ECHO) model, that is, a hub and spokes model of training Results Twenty-two PCDs participated in this program. Eleven of them got accredited at the end. The onsite orientation consisted of exposure to various psychiatry facilities at NIMHANS, in addition to learning psychiatric history taking and mental status examination. The ECHO model of online learning consisted of fortnightly sessions, lasting 2 hours each. There were 20 such sessions. Each session consisted of a didactic lecture by the psychiatrist followed by a case discussion. The cases were presented by PCDs, moderated by the hub specialists (NIMHANS). At the end of the training, participants rated an average of 4.5/5 on the mode, content and relevance of training and increase in knowledge due to the training. Around 23,000 patients were cared for during the said 1 year by the trained PCDs. Conclusion Training PCDs in a manner that enables retaining the learnt skills is feasible. However, rigorous evaluation protocols are needed in order to test this in a systematic fashion.
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Pahuja, Erika, Santosh Kumar, Ajay Kumar, Fareed Uzzafar, Siddharth Sarkar, Narayana Manjunatha, Yatan Pal Singh Balhara, C. Naveen Kumar, and Suresh Bada Math. "Collaborative Video Consultations from Tertiary Care Based Telepsychiatrist to a Remote Primary Care Doctor to Manage Opioid Substitution Therapy Clinic." Journal of Neurosciences in Rural Practice 11, no. 03 (June 12, 2020): 498–501. http://dx.doi.org/10.1055/s-0040-1713293.
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AbstractOpioid use is a major problem in India and has high morbidity and mortality with a prevalence of 2.06%. There is a huge treatment gap for opioid use disorders (OUDs). Due to limited mental health resources and limited psychiatric training of medical practitioners in OUDs, a significant proportion of patients do not receive appropriate medical intervention. This article demonstrates how a primary care doctor working in a remote opioid substitution therapy (OST) clinic received assistance from the optional opioid module of clinical schedule for primary care psychiatry (CSP) and collaborative video consultation (CVC) module to address specific difficulties of patients already on Buprenorphine OST and improve the quality of care, thereby reducing chances of relapses. CVC module is a part of one-year digitally driven primary care psychiatry program designed by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The opioid module was designed by NIMHANS, Bengaluru in collaboration with the All India Institute of Medical Sciences (AIIMS), New Delhi These observations warrant replication of this approach across diverse settings and at a larger scale to explore and evaluate its impact and effectiveness.
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Chaturvedi, Santosh K. "The International Fellowship Scheme: from Silicon Valley to the Potteries and back." Psychiatric Bulletin 30, no. 6 (June 2006): 226–27. http://dx.doi.org/10.1192/pb.30.6.226.
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I was one of the initial applicants to the NHS International Fellowship Scheme and joined the North Staffs Combined Healthcare NHS Trust in November 2003 as a consultant at the Greenfield Centre, Stoke on Trent. It had always been my dream to work in the UK as a consultant. I always wondered how similar it was to the consultant/ faculty position I held at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Here I describe my experiences.
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Navin, Karthick, Jayant Mahadevan, Richa Jain, and Sydney Moirangthem. "A Psychiatric-COVID Unit: The National Institute of Mental Health and Neuro Sciences (NIMHANS) Experience." Indian Journal of Psychological Medicine 43, no. 3 (April 27, 2021): 252–56. http://dx.doi.org/10.1177/02537176211006324.
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Sheth, Shabinabegam A. M., Bhavya Bairy, Aurobind Ganesh, Sumi Jain, Prabhat Chand, Pratima Murthy, and Sanjeev Arora. "Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India." BJPsych Open 7, S1 (June 2021): S157. http://dx.doi.org/10.1192/bjo.2021.438.
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AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.
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Sriram, T. G., C. R. Chandrashekar, Mohan K. Isaac, and R. Srinivasa Murthy. "Training primary care medical officers in mental health care: assessment using a structured clinical examination." Psychiatric Bulletin 14, no. 8 (August 1990): 481–82. http://dx.doi.org/10.1192/pb.14.8.481.
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Mental health problems in primary care settings have received wider attention in recent years (Wilkinson, 1985). In India, the National Mental Health Programme (NMHP) was formulated with the purpose of promoting mental health care through primary health care (National Mental Health Programme, 1982). As part of the implementation of NMHP, training programmes for medical officers and health workers have been initiated in a number of centres in the country (National Mental Health Programme for India, Progress Report, 1988). At the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, a monthly training programme for doctors and health workers of primary health centres has been carried out since 1982. In order to evaluate the gain in knowledge and clinical skills, a multiple-choice questionnaire and case vignettes have been standardised (Sriram et al, in press). The doctors are also evaluated through a structured clinical examination which is carried out on the last training day. The focus of the present report is to evaluate the clinical skills of medical officers using the structured clinical examination.
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., Harshitha. "Netflix Addiction- A Life Hacker: Short Communication." International Journal of Science and Healthcare Research 6, no. 3 (September 14, 2021): 395–400. http://dx.doi.org/10.52403/ijshr.20210765.
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Internet addiction is a behavioural addiction, similar to compulsive gambling, that can lead to behaviours similar to those seen in drug abuse disorders, such as bingeing. If we are not careful, internet and Netflix addiction might have a negative impact on our mental and physical health. Anxiety, depression, and loneliness can all be exacerbated by binge-watching. Any addiction requires the development of self-control and lifestyle changes that may provide a significant amount of diversion. The National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru has received the country's first case of Netflix addiction. Researchers have discovered instances when people's addiction has affected their interpersonal connections and caused them to lose productivity at work. The possibility of including Internet Addiction Illness as a diagnosable condition in the clinical setting has been investigated. Meditation and other alternative activities, such as sports or nature walks, should be encouraged; finding a good balance is essential for overall wellness. There hasn't been a lot of research on how binge-watching affects mental health because it's a relatively new phenomena that's only been around for around five years. Keywords: Internet addiction, Binge-Watching, Anxiety, Depression, and Loneliness.
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Rao, Manem Atchyuta, Sojan Antony, and Boban Joseph. "Influence of demographic profile and symptoms on insight among people with schizophrenia." Indian Journal of Psychiatric Social Work 11, no. 1 (February 4, 2020): 12. http://dx.doi.org/10.29120/ijpsw.2020.v11.i1.215.
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Introduction: Insight facilitation is an integral step to achieve good treatment outcome in schizophrenia. Low insight always leads to poor drug adherence and treatment resistance. The study aimed to examine how demographic profile and symptoms influencing the insight among people with schizophrenia. Methods and Materials: Objectives were to assess socio-demographic variables, the symptoms, and insight among people with Schizophrenia and to understand the influence of those variables on the insight. The descriptive research design opted for the study. Sample size of the quantitative study was 53, and subjects were selected as per the study inclusion and exclusion criteria. The population of the study was patients who were attending the outpatient department of psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS). Results: Age and age at the onset of illness were not associated with insight. Male participants had better insight compared to female participants. Persons with middle school or primary school education reported better insight than illiterate, graduates or professional graduates. Participants from the urban area had better insight than participants from the rural area. Insight and positive and negative symptoms were negatively correlated. Conclusion: The demographic factors and symptoms influence the insight among people with Schizophrenia. Hence such factors must be considered while insight facilitation for increasing the adherence to the treatment.
Keywords: Insight, schizophrenia, positive, negatives symptoms, age, gender, education, domicile
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Sinu, E., K. Sekar, and R. Dhanasekarapandian. "(A297) Psychosocial Care for Children Survivors of Tsunami Disaster - Pondicherry Response, India." Prehospital and Disaster Medicine 26, S1 (May 2011): s83. http://dx.doi.org/10.1017/s1049023x11002810.
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Tsunami left 7997 people dead in Tamil Nadu. Nagapattinam, Cuddalore and Kanyakumari districts were worst affected in terms of human and property loss.. Highest number of children death (1776) were reported in Nagai District. In Project Area, Totally 522 children died due to tsunami in Pondicherry (152), Cuddalore (222), Chennai (48) respectively. Considering massive death of Children in Tsunami Disaster, Rural Development Integrated organization (RIDO) along with partnership of Plan International and Technical Support from National Institute of Mental Health and Neuroscience (NIMHANS) provided psychosocial care for tsunami affected children in the regions of Union territory of Pondicherry, Cuddalore and Chennai. Totally 150 community level workers; 50 from each region were selected and trained for a period of 1 week on psychosocial care for children affected in Disaster through using different mediums by master trainers who underwent intensive Training of Trainers program on psychosocial care for tsunami affected children at National Institute of Mental Health and Neurosciences, Bangalore which is a nodal agency in India on psychosocial care in Disaster management. Psychosocial care program for tsunami affected children was carried out over a period of 2 years in afore said regions and handholding support was given to the community level workers periodically in the field. The psychosocial care program was provided for children in their own community by their own community volunteers through group based activities using different mediums. Mediums used to provide psychosocial care were unique in their own way which brought out the underlying emotions of children related to tsunami. Emotional perceptions differed among children across the age groups. Involving the community level workers in providing the psychosocial care for children survivors of tsunami disaster showed encouraging results. Challenges, limitations and lessons learnt in providing psychosocial care for tsunami affected children through community level workers will be discussed.
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Reddy, YC Janardhan, P. Srinivas Reddy, S. Srinath, S. Khanna, SP Sheshadri, and SC Girimaji. "Comorbidity in Juvenile Obsessive—Compulsive Disorder: A Report from India." Canadian Journal of Psychiatry 45, no. 3 (April 2000): 274–78. http://dx.doi.org/10.1177/070674370004500307.
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Objective: Using minimal exclusion criteria, to assess systematically the psychiatric comorbidity in children and adolescents with obsessive–compulsive disorder (OCD) and compare the findings with those of previous studies. Method: Fifty-four children and adolescents who satisfied DSM-III-R criteria for OCD were assessed using a structured interview schedule, the Children's version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and the questionnaire for tic disorders. All 54 subjects were recruited from the Child and Adolescent Psychiatry (CAP) services of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. Diagnoses were determined consensually after a review of all the available data. Results: Comorbidity was found in 69% of the sample: 22% were diagnosed with disruptive disorders; 20% met criteria for mood disorders; 19% had anxiety disorders; and 17% had tic disorders. Only 1 subject had bipolar disorder, and none had psychosis. The rates for individual diagnoses—in particular, the rates for disruptive disorders, bipolar disorder, and psychosis—were considerably lower than those reported in previous studies. Conclusions: Patterns of comorbidity in this study differed from those previously reported. Novel patterns of comorbidity with disruptive disorders, bipolar disorder, and psychosis reported in a few recent studies were not replicated in this study. These differences are probably due to different ascertainment methods. Comorbidity needs to be assessed in large epidemiological samples before definite associations can be made between certain comorbid disorders and juvenile OCD.
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Afsar, Mohammed, Dhaval Shukla, Binukumar Bhaskarapillai, and Jamuna Rajeswaran. "Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India." Journal of Neurosciences in Rural Practice 12, no. 02 (April 2021): 295–301. http://dx.doi.org/10.1055/s-0041-1722817.
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Abstract Objective Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI. Materials and Methods The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention. Statistical Analysis Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test. Results The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved. Conclusion CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.
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Gadad, A., D. Y. C. J. Reddy, D. G. Venkatasubramanian, and D. J. C.N. "Neuroimaging correlates of insight in obsessive compulsive disorder: A fMRI study." European Psychiatry 33, S1 (March 2016): S201. http://dx.doi.org/10.1016/j.eurpsy.2016.01.475.
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Aim of the studyTo study the neural substrates of insight in OCD by comparing patients with good insight, patients with poor insight and matched healthy controls using functional MRI.MethodologySubjects were recruited from among patients attending OCD clinic, adult psychiatry services and psychiatry ward inpatients of National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore. They were further divided into ‘good insight’ (n = 30) and ‘poor insight’ (n = 14) using Brown's assessment of belief's scale. Control subjects (n = 30) were recruited from consenting volunteers. 3 T MRI was used, mental rotation task was paradigm used for fMRI and analysis was done by SPM 8.ResultsPoor insight patients and Ggood insight patients comparison revealed differential activation in Left superior/Medial frontal gyrus (corresponding to the DLPFC). A negative correlation between BABS score and activation of right inferior parietal lobule. Mental Rotation task behavioural data results: OCD patients as a group had significantly lower accuracy compared to healthy controls. Poor insight group had significantly decreased accuracy ratio compared to Good insight group and healthy controls. A negative correlation was noted between BABS score and accuracy ratio, indicating that poorer the insight, greater the errors during the active task.ConclusionInsight has been important prognostic factor in OCD. Poor insight patients had specific deficits in left medial frontal gyrus and right inferior parietal lobule as compared to good insight patients and healthy controls. Together, these indicate that insight has a strong neurobiological underpinning in OCD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gadad, A., D. Y. C. J. Reddy, D. G. Venkatasubramanian, and D. J. C.N. "Neuroimaging correlates of insight in obsessive compulsive disorder: A fMRI study." European Psychiatry 41, S1 (April 2017): S409. http://dx.doi.org/10.1016/j.eurpsy.2017.01.344.
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Aim of the studyTo study the neural substrates of insight in OCD by comparing patients with good insight, patients with poor insight and matched healthy controls using functional MRI.MethodologySubjects were recruited from among patients attending OCD clinic, adult psychiatry services and psychiatry ward inpatients of National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore. They were further divided into ‘good insight’ (n = 30) and ‘poor insight’ (n = 14) using Brown's assessment of belief's scale. Control subjects (n = 30) were recruited from consenting volunteers. 3 T MRI was used mental rotation task was paradigm used for fMRI and analysis was done by SPM 8.ResultsPoor insight patients and good insight patients comparison revealed differential activation in left superior/medial frontal gyrus (corresponding to the DLPFC). A negative correlation between BABS score and activation of right inferior parietal lobule. Mental rotation task behavioural data results: OCD patients as a group had significantly lower accuracy compared to healthy controls. Poor insight group had significantly decreased accuracy ratio compared to good insight group and healthy controls. A negative correlation was noted between BABS score and accuracy ratio, indicating that poorer the insight, greater the errors during the active task.ConclusionInsight has been important prognostic factor in OCD. Poor insight patients had specific deficits in left medial frontal gyrus and right inferior parietal lobule as compared to good insight patients and healthy controls. Together, these indicate that insight has a strong neurobiological underpinning in OCD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Raju, Birudu, Kanmani T. R., Subhas Konar, Dhaval Shukla, and Raghavendra kukkehalli. "Prehospital Impact on Family Members of Road Traffic Accident." Journal of Neurosciences in Rural Practice 12, no. 02 (April 2021): 350–55. http://dx.doi.org/10.1055/s-0041-1723063.
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Abstract Background Prehospital care is nonexistent in most rural and semiurban areas. The implementation of golden hour care is still unachieved. The psychosocial problems of family members who accompany the traumatic brain injury (TBI) survivors after road traffic accidents (RTA) are not given attention during prehospital care. Therefore, the current study was aimed to understand the prehospital psychosocial impact on family members. Methodology A cross-sectional study was conducted at the Emergency and Trauma Care Centre at National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru between July 2017 to April 2018. Forty-five (n = 45) referred family members providing care for trauma survivors were purposively recruited in the study. Structured checklists were administered to measure the psychological reactions and psychosocial problems experienced by the family members during prehospital care. Data analysis was analyzed using the R software 3.0.1 version. Results TBI survivor's mean age was found to be 33 years (33.09 ± 13.20), of which males were 23 (51.1%) and females were 22 (48.9%), respectively. The result depicted first aid was provided by unskilled people after an average of 41 minutes (41 ± 30). The results further showed that family members had experienced agitation (100%), shock (82.2%), fatigue and headache (75.6%), depression (66.7%), feeling of hopelessness (55.6%) helplessness, and lack of support from family and financial constraints (48.9%) during prehospital care. Conclusion Psychosocial interventions need to be provided during prehospital care by trained medical and psychiatric social work professionals to address the need of family members during the crisis.
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Reddy, YC Janardhan, Satishchandra Girimaji, and Shoba Srinath. "Clinical Profile of Mania in Children and Adolescents from the Indian Subcontinent." Canadian Journal of Psychiatry 42, no. 8 (October 1997): 841–46. http://dx.doi.org/10.1177/070674379704200806.
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Objectives: To see whether classic DSM-III-R criteria for mania are applicable to Indian youngsters and to examine the clinical presentation of mania in an Indian child and adolescent psychiatric sample. Method: Fifty subjects with a diagnosis of functional psychosis as per the definition in ICD-9 were recruited from the population referred during the study period of approximately one year (n = 840) to the Child and Adolescent Psychiatry (CAP) clinic of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. The subjects were systematically evaluated using a standardized clinical interview and demographic questionnaire and were classified according to DSM-III-R. The subjects who satisfied DSM-III-R criteria for mania formed the sample for this study. Results: Twenty-one subjects received a diagnosis of mania according to DSM-III-R. The most common symptoms of mania included pressure of speech, irritability, elation, distractibility, increased self-esteem, expansive mood, flight of ideas, and grandiose delusions. No subject had comorbid attention-deficit hyperactivity disorder (ADHD). Additionally, 13 (61%) of the 21 manic subjects had delusions and/or hallucinations. The other common symptoms included psychomotor agitation, reduced sleep, anger, temper tantrums, decreased concentration, disobedience, aggression, and hyperactivity. Conclusions: Mania was diagnosable in Indian children and adolescents using classic DSM-III-R criteria. The clinical profile appears to be generally similar to that seen in adults. ADHD is not a comorbid condition. The presence of aggressive or disruptive behaviours and hyperactivity in childhood- and adolescent-onset mania, however, could lead to a misdiagnosis of attention-deficit hyperactivity disorder/conduct disorder (ADHD/CD). Similarly, the presence of psychotic features could lead to a misdiagnosis of schizophrenia.
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Goel, Deepak, Pradeep Aggarwal, Sunil Dutt Kandpal, Rakesh Kakkar, Deepak Negi, and Nidhi Mittal. "Epidemiology of New Onset Seizures and Epilepsy Cases: A Prospective Cohort Study." International Journal of Epilepsy 06, no. 01 (April 2020): 30–38. http://dx.doi.org/10.1055/s-0040-1712771.
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Abstract Introduction Incidence is the number of new epilepsy cases occurring during a given time interval, usually in 1 year, in a specified population. Most incidence studies of epilepsy are from developed countries with a rate of 40 to 70 per 100,000 population. Aims We conducted this survey to study incidence of all new onset unprovoked in rural and semiurban areas of the Uttarakhand State. This study is conducted on more than 100,000 of population with longitudinal follow-up of 3 years. Methods This was a community-based, longitudinal, observational study in two blocks of Dehradun district of Uttarakhand state. Total population of approximately 100,000 from two blocks will be surveyed (50,000 in each block). This door-to-door survey was conducted annually for 3 years duration from May 2014 to April 2017. The initial data were collected on National Institute of Mental Health and Neurosciences (NIMHANS) questionnaire by door-to-door survey. Results After longitudinal follow-up for 3 years of 103,610 of population in two blocks of Uttarakhand state, we found age-adjusted prevalence rate of unprovoked seizures to the tune of 623.63 cases per 100,000 of population. Age-adjusted incidence rate of epilepsy was 38.28 per 100,000 population and annual incidence of acute symptomatic seizures was 14.79 per 100,000 of population. Overall annual incidence rate of all afebrile seizures was 51.63 per of 100,000 people. Among all sociodemographic factors, age, poverty, diet, and hygiene were significantly associated with seizures. Conclusion Age-adjusted incidence rate of unprovoked seizure in Uttarakhand state was 38.28 per 100,000 people. Diet and hygiene were significant risk factors for seizures.
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Gautham, Melur Sukumar, Gopalkrishna Gururaj, Mathew Varghese, Vivek Benegal, Girish N. Rao, Arun Kokane, Bir Singh Chavan, et al. "The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity." International Journal of Social Psychiatry 66, no. 4 (March 4, 2020): 361–72. http://dx.doi.org/10.1177/0020764020907941.
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Background: Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015–2016. Aim: To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India. Methods: NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees. Results: The weighted lifetime prevalence of ‘any mental morbidity’ was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10–F19; 22.44%), mood disorders (F30–F39; 5.61%) and neurotic and stress-related disorders (F40–F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%. Conclusion: NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.
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Ganjekar, Sundarnag, Ajay Prakash, Harish Thippeswamy, Geetha Desai, and Prabha S. Chandra. "The NIMHANS (National Institute of Mental Health and Neuro Sciences) Maternal Behaviour Scale (NIMBUS): Development and validation of a scale for assessment of maternal behaviour among mothers with postpartum severe mental illness in low resource settings." Asian Journal of Psychiatry 47 (January 2020): 101872. http://dx.doi.org/10.1016/j.ajp.2019.101872.
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Necka, Elizabeth. "The National Institute of Mental Health: Research Agenda and Priorities in Geriatrics and Aging." Innovation in Aging 4, Supplement_1 (December 1, 2020): 621. http://dx.doi.org/10.1093/geroni/igaa057.2115.
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Abstract The Geriatrics and Aging Processes Research Branch of the National Institute of Mental Health (NIMH) supports research on the etiology, pathophysiology, and trajectory of late life mental disorders. The branch encourages research using neuroscience, cognitive and affective science, and social and behavioral science to translate basic and preclinical research to clinical research. The branch prioritizes research that investigates neuropsychiatric disorders of aging, how they interact with neurodevelopment/neurodegeneration, and how to assess, treat, and prevent them. Of particular interest is research on social isolation and suicide. Suicide prevention research is an urgent priority: NIMH’s portfolio includes projects aimed at identifying those at risk for suicide, understanding causes of suicide risk, developing suicide prevention interventions, and testing the effectiveness of these interventions and services in real-world settings. In this talk, a NIMH program official will discuss the NIMH research agenda in the domain of late-life mental illness, social isolation, and suicide.
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Fulmer, Russell, Angela Joerin, Breanna Gentile, Lysanne Lakerink, and Michiel Rauws. "Using Psychological Artificial Intelligence (Tess) to Relieve Symptoms of Depression and Anxiety: Randomized Controlled Trial." JMIR Mental Health 5, no. 4 (December 13, 2018): e64. http://dx.doi.org/10.2196/mental.9782.
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Background Students in need of mental health care face many barriers including cost, location, availability, and stigma. Studies show that computer-assisted therapy and 1 conversational chatbot delivering cognitive behavioral therapy (CBT) offer a less-intensive and more cost-effective alternative for treating depression and anxiety. Although CBT is one of the most effective treatment methods, applying an integrative approach has been linked to equally effective posttreatment improvement. Integrative psychological artificial intelligence (AI) offers a scalable solution as the demand for affordable, convenient, lasting, and secure support grows. Objective This study aimed to assess the feasibility and efficacy of using an integrative psychological AI, Tess, to reduce self-identified symptoms of depression and anxiety in college students. Methods In this randomized controlled trial, 75 participants were recruited from 15 universities across the United States. All participants completed Web-based surveys, including the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Positive and Negative Affect Scale (PANAS) at baseline and 2 to 4 weeks later (T2). The 2 test groups consisted of 50 participants in total and were randomized to receive unlimited access to Tess for either 2 weeks (n=24) or 4 weeks (n=26). The information-only control group participants (n=24) received an electronic link to the National Institute of Mental Health’s (NIMH) eBook on depression among college students and were only granted access to Tess after completion of the study. Results A sample of 74 participants completed this study with 0% attrition from the test group and less than 1% attrition from the control group (1/24). The average age of participants was 22.9 years, with 70% of participants being female (52/74), mostly Asian (37/74, 51%), and white (32/74, 41%). Group 1 received unlimited access to Tess, with daily check-ins for 2 weeks. Group 2 received unlimited access to Tess with biweekly check-ins for 4 weeks. The information-only control group was provided with an electronic link to the NIMH’s eBook. Multivariate analysis of covariance was conducted. We used an alpha level of .05 for all statistical tests. Results revealed a statistically significant difference between the control group and group 1, such that group 1 reported a significant reduction in symptoms of depression as measured by the PHQ-9 (P=.03), whereas those in the control group did not. A statistically significant difference was found between the control group and both test groups 1 and 2 for symptoms of anxiety as measured by the GAD-7. Group 1 (P=.045) and group 2 (P=.02) reported a significant reduction in symptoms of anxiety, whereas the control group did not. A statistically significant difference was found on the PANAS between the control group and group 1 (P=.03) and suggests that Tess did impact scores. Conclusions This study offers evidence that AI can serve as a cost-effective and accessible therapeutic agent. Although not designed to appropriate the role of a trained therapist, integrative psychological AI emerges as a feasible option for delivering support. Trial Registration International Standard Randomized Controlled Trial Number: ISRCTN61214172; https://doi.org/10.1186/ISRCTN61214172.
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Gopukumar Kumarpillai and Samhita K. "Cognitive Performance in Children with Refractory Mesial Temporal Sclerosis (MTS) – an Indian Experience." International Journal of Indian Psychology 5, no. 1 (December 25, 2017). http://dx.doi.org/10.25215/0501.108.
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The aim of the present study was to assess the effect of depression on cognitive performance in children with Mesial Temporal Sclerosis (MTS). Thirty-six MTS children were included in the study, and the subjects were set up by a median split of the scores obtained on the Centre for Epidemiological Studies – Depression Scale for Children (CES-DC), high depression (N = 15) and low depression (N = 21). The National Institute of Mental Health and Neurosciences (NIMHANS) Neuropsychological Battery was employed. High depressive subjects displayed impairment in verbal and visual memory functions. Overall, it was revealed that there is a significant relationship between the depression score and cognitive performance. It was concluded that high depression is associated with bi-temporal involvement of the brain.
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Ibrahim, Ferose Azeez, Barikar C. Malathesh, Gopi Gajera, Praveen Pandey, Lakshmi Nirisha P, Sonakshi Jyrwa, Channaveerachari Naveen Kumar, et al. "Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached." International Journal of Social Psychiatry, April 16, 2021, 002076402110111. http://dx.doi.org/10.1177/00207640211011191.
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Objective: Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings ( n = 2150). The objective of this article is to give a brief overview of the initiative Methods: CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. Results and conclusion: From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.
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Moyon, R. Shangmi, Bino Thomas, and Satish C. Girimaji. "Subjective experiences of dissociative and conversion disorders among adolescents in India." International Journal of Social Psychiatry, August 13, 2021, 002076402110361. http://dx.doi.org/10.1177/00207640211036178.
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Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their academics, and daily functioning, with high chances of developing other psychiatric comorbidities such as anxiety and depression. However, there are no studies that explore the experiences of suffering from dissociative/conversion disorders from perspective of the sufferer. Therefore, the paper has aimed at exploring the subjective experiences of dissociative and conversion disorders among adolescents in the Indian context by examining their understanding about the illness and the reason they ascribe to the cause of their illness. The study used a qualitative semi-structured interview to understand their illness. In total, 10 adolescents of age group between 12 and 16 years participated. Eight out of the 10 participants were female and the mean age was 12 years. All of them were in-patients in the department of Child and Adolescent Psychiatry, NIMHANS, which is the tertiary mental health care Institute India and pioneer Institute of mental health in Asia. All participants have had at least one or more consultation history either with a traditional healer or/and physician. Thematic analysis identified vital themes such as (1) Adolescents’ attributing factors of the illness, (2) Cognitive and emotional appraisal of stressful situation/s, (3) Adolescents’ appraisal of different explanatory model, (4) Living with the Impact of the illness. This analysis about dissociative/conversion disorders from adolescents’ perspective has a major contribution in enhancing the clinical knowledge and practice in planning and managing children/adolescents diagnosed with dissociative/conversion disorders.
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Gajera, Gopi, Barikar C. Malathesh, Lakshmi Nirisha P., Channaveerachari Naveen Kumar, Narayana Manjunatha, Suchandra H.H., Sujai Ramachandraiah, Chethan Basavarajappa, Rajendra Gowda K.M., and Suresh Bada Math. "Tele-Mentoring and Monitoring of the National Mental Health Program: A Bird’s-Eye View of Initiatives from India." Telehealth and Medicine Today, April 23, 2021. http://dx.doi.org/10.30953/tmt.v6.262.
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Objective: To provide a glimpse of various digital programs and modules that are being implemented across the country by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India (an institution of national importance under the Ministry of Health and Family Welfare, Government of India; one of its mandates is to develop innovative strategies to improve mental health capacity building as part of the National Mental Health Program, a publicly funded health program to cater to the public health need posed by psychiatric disorders). Design: The information is presented in a narrative fashion by organizing the activities into three categories of digital training methods: webinar mode, blended mode and hybrid mode. Results: Cadres ranging from lay-counsellors (volunteers in the community), non-specialist health workers to professionals including medical officers are covered with these initiatives. During the period from August 2016 till December 2020, more than 16 million man hours of training is delivered for more than 35,000 participants from across the country. Conclusions: These have a tremendous potential to exponentially increase skilled human resources capable of providing quality care to hitherto unserved remote areas of the rural hinterland and ultimately reduce the burgeoning treatment gap. In-depth outcome assessments are the need of the hour.
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John, Arun, Santanu Deb, Palash R. Gogoi, Jasmine Mary Lyngdoh, Prasenjit Paul, Sabrina Yesmin, Pramod Paharia, and Anamika Kishnan. "MEMORY STATUS AMONG CHILDREN WITH EPILEPSY." INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, February 1, 2021, 33–35. http://dx.doi.org/10.36106/ijsr/7404107.
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Objective: To study the status of visual and verbal memory status among children with epilepsy and effects on schooling. Methods:This descriptive cross-sectional study enrolled children aged 5 to 15 years who have been diagnosed to have epilepsy and has been seizure free during last one month. Enrolled children (81) were evaluated by using two sub tests selected from the National Institute of Mental Health and Neuro Sciences(NIMHANS) Neuropsychological Battery for Children, Rey’s Auditory Verbal Learning test and Memory for Designs test, for verbal and visual memory status respectively and the child was graded on the basis of the standard scores. Schooling details were obtained by questioners to care taker. Results: Memory impairment (MI) was identied in 50 (61.7%) Children with Epilepsy (CWE) (predominantly verbal memory impairment). 20 (25%) CWE were not attending age appropriate class. Among these 20 CWE, 17(85%) children had memory impairment. p: 0.01. There were 25 CWE performing poorly, among them 22(88%) children had memory impairment. p <0.0024. A total of 8 children were school dropouts and all 8 had MI (100%).Conclusions:MI was found to be very common in CWE. MI among CWE was found to negatively inuence age appropriate schooling and school performance. Early screening and appropriate support may improve the outcome.
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Paul, Pradip, Ravi Kumar Nadella, Somdatta Sen, Dhruva Ithal, Jayant Mahadevan, Janardhan Reddy Y C, Sanjeev Jain, Meera Purushottam, and Biju Viswanath. "Association study of BDNF Val66Met gene polymorphism with bipolar disorder and lithium treatment response in Indian population." Journal of Psychopharmacology, July 27, 2021, 026988112110326. http://dx.doi.org/10.1177/02698811211032609.
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Background: The association of the Val66Met (rs6265) polymorphism in the brain-derived neurotrophic factor ( BDNF) gene with bipolar disorder (BD) and response to lithium treatment has been suggested, though inconsistently. The considerable diversity of allele frequency across different populations contributes to this. There is no data from South Asia till date. Hence, we examined the association of this polymorphism in BD cases from India, and its association with lithium treatment response. Methods: BD patients ( N = 301) were recruited from the clinical services of National Institute of Mental Health and Neurosciences (NIMHANS), India. Lithium treatment response for 190 BD subjects was assessed using Alda scale by NIMH life charts. Patients with total score ⩾7 were defined as lithium responders ( N = 115) and patients with score <7 were defined as lithium non-responders ( N = 75). Healthy controls ( N = 484) with no lifetime history of neuropsychiatric illness or a family history of mental illness were recruited as control set. Genotyping was performed by TaqMan genotyping assay. Results: Genotype and allele frequency of BDNF Val66Met SNP was significantly different (χ2 = 7.78, p = 0.02) in cases compared to controls, and the Val(G) allele was more frequent (χ2 = 7.08, p = 0.008) in BD patients. However, no significant difference is noted in genotype or allele frequencies of this polymorphism between the lithium responders and non-responders. Conclusions: The Val(G) allele of BDNF Val66Met polymorphism is associated with risk of BD in this sample, but it is not related to response to lithium.
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"Mental Stress and Food we eat." PERSPECTIVES IN MEDICAL RESEARCH, September 10, 2020. http://dx.doi.org/10.47799/pimr.0802.01.
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Mental disorders affect everyone, irrespective of age, gender, residence, and living standards, and even though some groups are at a higher risk for certain illnesses; only the impact varies. At a global level, over 564 million people are estimated to suffer from depression and anxiety, equivalent to 8.0% of the world’s population. Both depression and anxiety disorders are more common among females than males (4.6% compared to 2.6% at the global level).[1] National mental health survey 2015-16 implemented by the National Institute of Mental Health and Neuro-Sciences (NIMHANS) Bengaluru put the figures of 1 in 20 people in India suffer from depression. The high prevalence of moderate and high dependence tobacco use and alcohol abuse was 20.9% and 4.6%, respectively. These are not the isolated scenario as mental disorders are caused by a complex interaction of biological, social, environmental, cultural, and economic factors. One of the complex interaction is food and nutrition.[2] Why link mental stress with food: Most of the world's population live in countries where overweight (global prevalence 39%) and obesity (13%) kills more people than underweight. Unfortunately, we are now 8 months into the COVID-19 pandemic, and the end of the crisis is nowhere near, a different domain of public health requires urgent attention. Additionally, there are major shifts in dietary intakes globally, with a substantial increase in the consumption of sugars, snack foods, take-away foods, and high-energy foods. At the same time, the intake of whole-grain fiber-rich nutritious foods is diminishing. These changes are particularly obvious in the younger and working population. Indeed, the latest data from the Global Burden of Disease Study found that an unhealthy diet is now the leading cause of early death. The type and quality of the food we eat, affect our mental health. And any mental illness may affect the type and pattern of our eating.