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Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of... more
Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics, and to examine the association of risk clusters with manifest psychopathology. Participants (n = 8300) between 6 and 23 years were recruited from seven sites in India. We administered questionnaires to elicit history of previous exposure to adverse childhood environments, family history of psychiatric disorders in first-degree relatives, and a range of antenatal and postnatal adversities. We used these variables to generate risk clusters. Mini-International Neuropsychiatric Interview-5 was administered to evaluate manifest psychopathology. Two-step cluster analysis revealed two clusters designated as high-risk cluster (HRC) and low-risk ...
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When data is pooled across multiple sites, the extracted features are confounded by site effects. Harmonization methods attempt to correct these site effects while preserving the biological variability within the features. However, little... more
When data is pooled across multiple sites, the extracted features are confounded by site effects. Harmonization methods attempt to correct these site effects while preserving the biological variability within the features. However, little is known about the sample size requirement for effectively learning the harmonization parameters and their relationship with the increasing number of sites. In this study, we performed experiments to find the minimum sample size required to achieve multisite harmonization (using neuroHarmonize) using volumetric and surface features by leveraging the concept of learning curves. Our first two experiments show that site-effects are effectively removed in a univariate and multivariate manner; however, it is essential to regress the effect of covariates from the harmonized data additionally. Our following two experiments with actual and simulated data showed that the minimum sample size required for achieving harmonization grows with the increasing aver...
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With the growth of decentralized/federated analysis approaches in neuroimaging, the opportunities to study brain disorders using data from multiple sites has grown multi-fold. One such initiative is the Neuromark, a fully automated... more
With the growth of decentralized/federated analysis approaches in neuroimaging, the opportunities to study brain disorders using data from multiple sites has grown multi-fold. One such initiative is the Neuromark, a fully automated spatially constrained independent component analysis (ICA) that is used to link brain network abnormalities among different datasets, studies, and disorders while leveraging subject-specific networks. In this study, we implement the neuromark pipeline in COINSTAC, an open-source neuroimaging framework for collaborative/decentralized analysis. Decentralized analysis of nearly 2000 resting-state functional magnetic resonance imaging datasets collected at different sites across two cohorts and co-located in different countries was performed to study the resting brain functional network connectivity changes in adolescents who smoke and consume alcohol. Results showed hypoconnectivity across the majority of networks including sensory, default mode, and subcort...
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Background Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse. Methods Data from... more
Background Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse. Methods Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure. Results 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compare...
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Severe Mental Illnesses, such as bipolar disorder and schizophrenia, are highly heritable, and have a complex pattern of inheritance. Genome wide association studies detect a part of the heritability, which can be attributed to common... more
Severe Mental Illnesses, such as bipolar disorder and schizophrenia, are highly heritable, and have a complex pattern of inheritance. Genome wide association studies detect a part of the heritability, which can be attributed to common genetic variation. Examination of rare variants with Next Generation Sequencing may add to the understanding of genetic architecture of SMIs. We analyzed 32 ill subjects from 8 multiplex families; and 33 healthy individuals by whole exome sequencing. Prioritized variants were selected by a 3-step filtering process, which included deleteriousness by 5 in silico algorithms; sharing within families by affected individuals, rarity in South Asian sample estimated using the Exome Aggregation Consortium data and complete absence of these variants in a control-individuals from the same gene pool. We identified 42 rare, non-synonymous deleterious variants (~5 per pedigree) in this study. None of the variants were shared across families, indicating a 'privat...
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There is a need for a short instrument to assess the multiple areas of dysfunction as well as drinking dyscontrol in alcoholics. The Brief Addiction Rating Scale (BARS), covering 10 areas of functioning has been developed to meet this... more
There is a need for a short instrument to assess the multiple areas of dysfunction as well as drinking dyscontrol in alcoholics. The Brief Addiction Rating Scale (BARS), covering 10 areas of functioning has been developed to meet this need. This report describes the rationale and development of this new scale. A high interrater reliability (0.9) on all the items of the scale and the ease of administration justify its clinical and research use.
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This study aimed at evaluating patient and treatment variables influencing six month treatment outcome in alcohol dependence. 134 serially registered patients selected their treatment setting as either outpatient or inpatient.... more
This study aimed at evaluating patient and treatment variables influencing six month treatment outcome in alcohol dependence. 134 serially registered patients selected their treatment setting as either outpatient or inpatient. Sociodemographic variables, alcohol consumption patterns, drinking consequences were measured at intake. Following treatment, drinking patterns and consequences were re-measured at three and six months follow up in each of the groups. 86 of 134 chose the inpatient program and 48 the outpatient program. Overall, 58 maintained total abstinence, and 11 had significantly reduced alcohol consumption at six months follow up. The inpatient group did marginally better than the outpatient group. More severely dependent patients, those with greater physical and psychosocial consequences opted for an inpatient program, and did well. Less severely dependent patients did favourably with outpatient intervention alone. Improvements made within the first three months tended t...
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Research Interests: Cardiology, Biomedical Engineering, Audiology, Digital Signal Processing, Biomedical signal and image processing, and 15 moreAutonomic Nervous System, Biological Sciences, Biological Psychiatry, Cues, Alcoholism, Alcohol Drinking, Biological, Heart rate, Cardiology Research, Alcohol dependence, Adult, Alcoholics, Elsevier, Autonomic, and Deaddiction
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Excessive use of the internet for gambling, gaming and behavioural addiction, are a focus of contemporary interest. The authors delve into the archives to explore the connections between the growth of various forms of technology,... more
Excessive use of the internet for gambling, gaming and behavioural addiction, are a focus of contemporary interest. The authors delve into the archives to explore the connections between the growth of various forms of technology, commerce, addictive behaviours and responses of the State, in colonial India. The interplay between the growth of the telegraph network in 19th century India, and its influence on various forms of gambling, including speculation on opium prices, and the rain, as a theme of wager make interesting stories, as do the governmental responses to these. Clinical and social responses to information technology raised much the same concerns as they do now.
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PURPOSE To obtain nurses' perspectives regarding integrated interventions for substance use cessation for patients in general hospital settings. DESIGN AND METHODS (a) Quantitative survey (N = 207) (nurses' knowledge, attitude,... more
PURPOSE To obtain nurses' perspectives regarding integrated interventions for substance use cessation for patients in general hospital settings. DESIGN AND METHODS (a) Quantitative survey (N = 207) (nurses' knowledge, attitude, practice, confidence regarding integrated interventions; (b) Focus groups exploring nurses' perspectives regarding integrated interventions (N = 32). FINDINGS Participants' scores (mean, SD): Knowledge-112.5 (10.4) (maximum score-198); Attitude-30.99 (7.05) (maximum-52); Practice-1.66 (2.63) (maximum-28); Confidence-11.90 (3.82) (maximum-24). From the focus groups, four themes were identified: Substance use patterns among patients seeking treatment at the hospitals where the nurses are employed; Nurses' role in providing integrated interventions; Nurses' training needs for providing integrated interventions; Feasibility of providing integrated interventions. PRACTICE IMPLICATIONS Findings provide clear justification for module development to train nurses in providing integrated interventions.
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A major goal of long-term management of substance use disorders is to empower recovering individuals in resisting drug use when confronted with real-world high-risk situations (cues). Since opportunities to reproduce and learn from... more
A major goal of long-term management of substance use disorders is to empower recovering individuals in resisting drug use when confronted with real-world high-risk situations (cues). Since opportunities to reproduce and learn from real-life situations are limited in treatment settings, the key is to bring those real-world drug use cues to the treatment setting through vicarious learning. Cue-exposure approaches achieve this by presenting these cues while the usual drug-use response is prevented. This provides opportunity to practice how to deal with the cues before being discharged from the treatment setting. Videos are one way to present the cues as well as demonstrate how to deal with them successfully. In this article, we discuss our experiences with the use of videos to model relapse prevention strategies for specific cues, and provide some future directions for the use of video-based interventions for relapse prevention in substance use disorders.
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Non-medical prescription drug use is an ongoing problem in India; however, there is paucity of literature in the Indian population. The objective of the present study is to explore the non-medical use of prescription medicines in urban... more
Non-medical prescription drug use is an ongoing problem in India; however, there is paucity of literature in the Indian population. The objective of the present study is to explore the non-medical use of prescription medicines in urban Bangalore, South India (N = 717). Participants were recruited using a mall-intercept approach, wherein they were intercepted in 5 randomly selected shopping malls, and interviewed on their use of prescription medicines. The mean age of the participants was 28 years (S.D. 5). The non-medical use of different prescription medicine classes over the past 12 months was as follows: anti-inflammatories and analgesics (26%), opioids (17%), antibiotics (13%), and sedatives (12%). The majority reported "use without prescription," while "use in ways other than as prescribed" was also reported. In all cases, chemist shops were the main source of obtaining the drugs non-medically. In multivariate logistic regression analyses, non-medical use was found to be significantly associated with participants' baseline characteristics like gender, education, current employment status, and marital status. Sixty-five percent stated that although "doctor's prescription is not required for common complaints, we can decide ourselves," while 60% stated, "it's okay to deviate from a prescription as needed." One hundred percent said that "using prescription medicines is more socially acceptable, and safer, compared to alcohol or illicit drugs." These findings underscore the need for considering various contextual factors in tailoring preventive interventions for reducing non-medical use of prescription drugs.
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Background: Substance use among college students is increasing, yet research regarding their viewpoints on how they can be helped is sparse in India. Aim: The purpose of this study was to explore in depth the perspectives of college... more
Background: Substance use among college students is increasing, yet research regarding their viewpoints on how they can be helped is sparse in India. Aim: The purpose of this study was to explore in depth the perspectives of college students as to how college youth can be helped to quit the use of psychoactive substances. Method: Data from focus group interviews with 38 adolescent college students were analyzed qualitatively to identify their viewpoints on how today’s college youth can be helped to quit substance use. Interviews were transcribed verbatim, themes and subthemes were identified. Results: Three major themes (with subthemes) were identified: (1) Patterns of use (commonly used substances, methods of using), (2) Perceived reasons for use (to reduce negative emotions, academic pressure, peer influence, more freedom, rebellious attitudes, media influence, modeling effect, childhood trauma, distrust from family/friends, lack of knowledge regarding the adverse impact of substances, poor life skills, cultural gender-based discrimination) and (3) Interventions needed to help college youth to quit substance use (need for interventions, basic principles to follow when developing interventions, content to be included, methods to be employed for delivering the intervention). Conclusion: The information from this study can guide the development of a comprehensive intervention that is relevant and tailor-made to the specific needs of the college student population.
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ABSTRACTIntroductionThe increasing burden of depression and non-communicable disease (NCD) is a global challenge, especially in low- and middle-income countries (LMIC) considering the resource constraints and lack of manpower in these... more
ABSTRACTIntroductionThe increasing burden of depression and non-communicable disease (NCD) is a global challenge, especially in low- and middle-income countries (LMIC) considering the resource constraints and lack of manpower in these settings. Brief psychological therapies such as behavioural activation (BA), have shown to be effective for the treatment of depression. However, their feasibility and effectiveness for depression in people with NCDs in Indian community setting has not been systematically evaluated. Hence, in this study, we conceptualize to adapt BA into Indian NCD context, thus to improve the management of depression in people with NCD in India.AimsTo (1) adapt BA for the Indian NCD context, (2) test the acceptability, feasibility and implementation of the adapted BA intervention (BEACON intervention package, BIP), and (3) test the feasibility of a randomised controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care.MethodsFo...
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ObjectivesThis study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and... more
ObjectivesThis study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and alcohol sales data.DesignA retrospective time-series analysis.SettingEmergency department of a tertiary level hospital located in a metropolitan city of southern India. This centre is dedicated to neurological, neurosurgical and psychiatric care.ParticipantsDaily counts of TBI patients seen between 1 December 2019 and 3 January 2021 (400 days); n=8893. To compare the profile of TBI cases seen before and during the pandemic, a subset of these cases seen between 1 December 2019 and 31 July 2020 (244 days), n=5259, are studied in detail.ResultsAn optimal changepoint is detected on 20 March 2020 following which the mean number of TBI cases seen every day has decreased and variance has increased (mean 1=29.4, variance 1=50.1; mean 2=19.5, variance 2=59.7...
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Indian models of personality are seldom explored in relation with alcohol dependence. Triguna is an Indian model of personality originating from Sankhya philosophy, whereby three gunas, Sattva, Rajas and Tamas describe personality... more
Indian models of personality are seldom explored in relation with alcohol dependence. Triguna is an Indian model of personality originating from Sankhya philosophy, whereby three gunas, Sattva, Rajas and Tamas describe personality features. Anasakti has been discussed extensively in Bhagavad Gita and is an equivalent for the concept of non- attachment.The current study discusses these two Indian concepts and attempts to explore their relationship with personality and subjective well-being, among males with and without alcohol dependence.A cross-sectional survey method was adopted, with a sample of 84 males from community without alcohol dependence, screened through AUDIT and 30 males diagnosed with alcohol dependence. Informed consent was obtained from all the participants. The data was analysed using descriptive statistics, independent sample t-test and Mann-Whitney U-test.The males without alcohol dependence scored significantly higher on variables such as Sattva, extraversion and...
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The current study aimed to explore the relationship of Triguna model of Indian psychology, and Anasakti with respect to meta traits of personality as well as affect.A cross sectional survey method was adopted for the current study and it... more
The current study aimed to explore the relationship of Triguna model of Indian psychology, and Anasakti with respect to meta traits of personality as well as affect.A cross sectional survey method was adopted for the current study and it was conducted after approval by the institute ethics committee. A total of 84 males between the age of 18-50 years with a minimum of 10 years of formal education were selected from colleges and various organizations. The study was approved by the Institute ethics committee.Vedic personality Inventory, Big five aspect scale, Positive and negative affect schedule, and Non- attachment scale were used in the study. A quantitative statistical analysis was carried out using SPSS. An integration of the Indian model of personality with the western concept of general factor of personality (GFP) was carried out here and Sattva was found to be positively correlated with the general factor of personality. Anasakti was also moderately correlated with the general...
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IntroductionThe prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking,... more
IntroductionThe prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention (i.e., the IMPACT 4S intervention) that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial.MethodsWe will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S inter...
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Lithium is an effective, well-established treatment for bipolar disorder (BD). However, the mechanisms of its action, and reasons for variations in clinical response, are unclear. We used neural precursor cells (NPCs) and lymphoblastoid... more
Lithium is an effective, well-established treatment for bipolar disorder (BD). However, the mechanisms of its action, and reasons for variations in clinical response, are unclear. We used neural precursor cells (NPCs) and lymphoblastoid cell lines (LCLs), from BD patients characterized for clinical response to lithium (using the “Alda scale” and “NIMH Retrospective Life chart method”), to interrogate cellular phenotypes related to both disease and clinical lithium response. NPCs from two biologically related BD patients who differed in their clinical response to lithium were compared with healthy controls. RNA-Seq and analysis, mitochondrial membrane potential (MMP), cell viability, and cell proliferation parameters were assessed, with and without in vitro lithium. These parameters were also examined in LCLs from 25 BD patients (16 lithium responders and 9 non-responders), and 12 controls. MMP was lower in both NPCs and LCLs from BD; but it was reversed with in vitro lithium only in...
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ObjectiveAdverse Childhood Experiences (ACEs) are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of ACEs and their relation to the age of onset (AAO) of major psychiatric... more
ObjectiveAdverse Childhood Experiences (ACEs) are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of ACEs and their relation to the age of onset (AAO) 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.MethodsOur sample consisted of 509 individuals from 215 families. Of these, 268 were affected i.e diagnosed with bipolar disorder (BPAD) (n=61), obsessive-compulsive disorder (OCD) (n=58), schizophrenia (n=52), substance dependence (SUD) (n=59), or co-occurring diagnoses (n=38); while 241 were at-risk first degree relatives (FDRs) 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 (ACE-IQ) and ACE binary and frequency scores were calculated...
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Sir, Physicians are at a higher risk of substance use disorders (SUD) in view of the stressful nature of their job and easy access to medicines1,2. The pattern, prevalence and characteristics of substance abuse in physicians are different... more
Sir, Physicians are at a higher risk of substance use disorders (SUD) in view of the stressful nature of their job and easy access to medicines1,2. The pattern, prevalence and characteristics of substance abuse in physicians are different from the general population2. Alcohol use among medical students and practicing physicians is a growing concern in India3.There is limited information available on physicians with SUD from India. This study was conducted at the Centre for Addiction Medicine (CAM), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India, after approval from the Institute Ethics committee. The study was a retrospective database based analysis. The database contained information of all the in-patients’ socio-demographic details, clinical history, examination findings and treatment details. These details were entered in the database after evaluation of each case independently by at least two qualified psychiatrists. We extracted the data from July 2007 to June 2012. During this period, there were 58 physicians admitted to the CAM. Descriptive statistics was used to analyse the data. The demographic and clinical details are as mentioned in the Table. Table Demographic and clinical details of physicians admitted (2007-2012) (n=58) The sex ratio was in keeping with general trend of treatment seekers in India4. The physicians in our study had a later onset of initiation of substance use (26 ± 8 yr) and dependence criteria (32 ± 8 yr) than the rest of the treatment seeking population5,6,7. But this was in concordance with the other available literature of SUD in physicians2. Also these physicians had taken 10 years to come for treatment after the dependence pattern was established. Among these physicians about 58 per cent were using prescription drugs as one of their primary substances of abuse. All those who abused opioid, were using prescription opioids. Cannabis was used in 13 per cent as secondary substance of abuse. The profile was different from rest of the substance users’ population because cannabis usage was found to be low and benzodiazepine users were more4. This could be explained by the fact that this study looked at the primary drugs of abuse for which these physicians got admitted to the hospital and also there was easy accessibility to benzodiazepines for physicians. Of the 58 physicians studied, 34 (58%) had comorbid psychiatric disorders. The disorders were mood disorders in 23 (39%), anxiety disorders in seven (12%), and psychotic spectrum disorders in four (7%). Marital discord was found in 23 (40%) of them. On the routine assessment of premorbid temperament it was found that 21 (37%) had externalising traits (ADHD, conduct disorder and oppositional defiant disorder related symptoms), 10 (18%) had internalising traits (depression and anxiety related symptoms) and six (11%) had both externalising and internalising traits. At the time of entry into the treatment 12 (20%) were in pre-contemplation phase, 23 (40%) in contemplation and 23 (40%) in preparatory phase of motivation. As there was no uniform treatment policy and there were lapses and relapses, follow up duration was taken as an outcome factor in the study. Nineteen (33%) of them were never followed up after discharge, 19 (33%) dropped out of treatment within one year after the admission, 20 (34%) were on follow up regular treatment even after one year. Mean duration of follow up in the later was 13 months. Although the follow up rates were relatively better than that in the general patients with SUD8, it was poorer when compared to the western literature9,10. This can be explained by the non-availability of good documentation and reporting systems in case of treatment dropouts especially in physicians11. The limitations of this study were small sample size, retrospective reviewing of the database and inclusion of only in-patients in the study. This limits the generalizability of the findings. In conclusion, physicians are in the risk group for SUD with respect to availability and accessibility to prescription medications. There is a need to study the community prevalence and treatment barriers in this group leading to delay in treatment seeking and poor follow up rate.
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BackgroundLow and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA),... more
BackgroundLow and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalizing disorders.MethodscVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up. Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges. 10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the fa...
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Supplemental material, Description_of_Total_ACE_Exposure_Score for Adverse childhood experiences in families with multiple members diagnosed to have psychiatric illnesses by Amala Someshwar, Bharath Holla, Preeti Pansari Agarwal, Anza... more
Supplemental material, Description_of_Total_ACE_Exposure_Score for Adverse childhood experiences in families with multiple members diagnosed to have psychiatric illnesses by Amala Someshwar, Bharath Holla, Preeti Pansari Agarwal, Anza Thomas, Anand Jose, Boban Joseph, Birudu Raju, Hariprasad Karle, M Muthukumaran, Prabhath G Kodancha, Pramod Kumar, Preethi V Reddy, Ravi Kumar Nadella, Sanjay T Naik, Sayantanava Mitra, Sreenivasulu Mallappagiri, Vanteemar S Sreeraj, Srinivas Balachander, Suhas Ganesh, Pratima Murthy, Vivek Benegal, Janardhan YC Reddy, Sanjeev Jain, Jayant Mahadevan and Biju Viswanath in Australian & New Zealand Journal of Psychiatry
IntroductionPeople with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the... more
IntroductionPeople with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia.Methods and analysisWe will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General ...
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INTRODUCTION The rates and intensity of tobacco use are higher in persons with schizophrenia spectrum disorders (PwS) compared to the general population, contributing to increased morbidity and mortality. We aimed to systematically review... more
INTRODUCTION The rates and intensity of tobacco use are higher in persons with schizophrenia spectrum disorders (PwS) compared to the general population, contributing to increased morbidity and mortality. We aimed to systematically review randomised control trials (RCTs) that used non-pharmacological interventions to reduce or cease tobacco use in PwS. METHODS We searched PubMed, EBSCO, ProQuest and PsycINFO for RCTs, published between January 2004 and December 2019, which included adult PwS. Studies providing self-reported or biochemically measured reduction of tobacco use and cessation after a minimum follow-up period of 6 months were included. We used the Cochrane Risk of Bias (ROB) tool for assessing the quality of selected studies. RESULTS Of the six included trials, two compared non-pharmacological interventions alone while four compared combinations with pharmacological interventions with routine care. The non-pharmacological interventions varied widely. Continuous abstinence and seven days point-prevalence abstinence (7 PPA) were reported in 2 and 4 studies respectively, with one study assessing both. All six trials measured reduction in the number of cigarettes smoked, but only two trials reported significant reductions in intervention groups. No worsening of psychiatric symptoms was reported. CONCLUSIONS Two trials were rated as "low risk", and 4 trials as "some concerns" on the ROB tool. Heterogeneity among trials precluded meta-analysis. Abstinence was significantly higher among groups who were given combination interventions, and intervention groups in studies showed significantly greater or a trend towards reduction in the number of cigarettes smoked than controls. No specific method of non-pharmacological management was conclusively favoured. IMPLICATIONS Reduction in cigarettes smoked seemed to significantly favour or show non-significant trends favouring intervention groups over controls, while abstinence was significantly higher among groups in studies that used specific combination interventions. Combinations of pharmacological and non-pharmacological treatment were better than non-pharmacological interventions used in isolation, for facilitating abstinence and reduction in cigarettes smoked. Specific interventions such as home visits and contingent reinforcement merit further study. Trials included in this study were conducted in high-income and upper-middle-income countries. Thus, the application of these interventions to low and middle-income countries (LAMICs) needs to be further studied.
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The present study was conducted to ascertain the effectiveness of Project ECHO, a Hub and Spokes tele-mentoring model to bridge the urban-rural divide in mental health and addiction care in the context of a developing country like India.... more
The present study was conducted to ascertain the effectiveness of Project ECHO, a Hub and Spokes tele-mentoring model to bridge the urban-rural divide in mental health and addiction care in the context of a developing country like India. The Counsellors from 11 rural and underserved districts of Chhattisgarh were periodically connected to NIMHANS multidisciplinary specialists by smartphone app and underwent virtual mentoring to learn and translate "best practices" in Mental health and Addiction by using "patient-centric learning", a core component of NIMHANS ECHO model. The outcome evaluation was modelled on Moore's evaluation framework focusing on participant engagement, satisfaction, learning, competence and performance. Over the period of 6 months i.e. 12 tele-ECHO clinics, 41 patients case summaries were discussed by the Counsellors with NIMHANS Hub Specialists. Half of the counsellors could join >80% clinics and overall there were no drop-outs. There ...
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S174 disturbed and agitated individual, rather than pondering on the larger meanings and consequences of societal or personal inequity. The difficulty, however, is when this “call to action” prevents us from stopping to think of what we... more
S174 disturbed and agitated individual, rather than pondering on the larger meanings and consequences of societal or personal inequity. The difficulty, however, is when this “call to action” prevents us from stopping to think of what we need to do, apart from what seems to be the obvious. In that sense, our approaches and attitudes will be informed by what we know of what has gone before, and that is limited only by what our “listening ear” lets us hear, or what we train it to hear.
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Delirium tremens (DT) is a medical emergency. Many cases are treated and discharged from emergency services (ES), after complete or partial resolution of delirium. Few receive comprehensive inpatient addiction treatment (CIAT) after the... more
Delirium tremens (DT) is a medical emergency. Many cases are treated and discharged from emergency services (ES), after complete or partial resolution of delirium. Few receive comprehensive inpatient addiction treatment (CIAT) after the initial emergency management. The objective of this study was to compare 6-month outcomes of treatment in alcohol-dependence syndrome (ADS) patients presenting with DT receiving either only emergency care or emergency care along with CIAT. In this prospective observational study, all patients of ADS presenting in DT over a 1-year period were followed up for 6 months. Patients who received care only in the emergency services (ES) (111) were compared with patients who received ES followed by CIAT (90). Primary followup measure was regular followup (RFU) at outpatient department, and patients not presenting for RFU received telephonic followup (TFU). Alcohol use status was monitored at 6 months, as per Feuerlein and Küfner criteria. Patients who receive...
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The study objective was to assess the value of outpatient follow-up of patients who undergo routine uncomplicated nasal surgery. A total of 177 postoperative patients (117 males, 60 females) undergoing routine nasal surgery at the... more
The study objective was to assess the value of outpatient follow-up of patients who undergo routine uncomplicated nasal surgery. A total of 177 postoperative patients (117 males, 60 females) undergoing routine nasal surgery at the Raigmore Hospital, Inverness, was selected over a six-month period, 92 of whom (60 males, 32 females) were requested to return to the clinic for a follow-up session. A total of 72 (78.3%) patients attended for post-operative review. Of these, 55 patients (76.4%) had achieved a satisfactory result from surgery and 17 (23.6%) required additional treatment for persistent problems. The former group were pleased with the outcome of their operation and required no further treatment. Of the 25 patients who were prescribed medication at the time of discharge from hospital, 19 (76.0%) were still complying with the medication and required no further specialist assistance. The results suggest that routine follow-up of uncomplicated cases of nasal surgery is unnecessa...
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The authors provide an overview of the development of psychiatric services in India. They track the early developments in ancient and medieval periods, and after Western medicine made its appearance. Lunatic Asylums were established in... more
The authors provide an overview of the development of psychiatric services in India. They track the early developments in ancient and medieval periods, and after Western medicine made its appearance. Lunatic Asylums were established in India by the East India Company, and extended to various parts of the country, under British rule. The spread of medical education and services was quite slow, and there were very few psychiatrists, and a small number of beds by mid-twentieth century. Publicly funded universal health care, planned on similar lines as the NHS at the eve of Independence, did not develop sufficiently in subsequent decades. Economic and social disruption, and low priority to spending on health care thwarted efforts at extending the services. The development of pharmacological treatments in the 1950s raised the possibility of general hospital-based psychiatric services, at least of severe mental illness. Importantly, efforts to understand the psychosocial causes and correlates of both common and severe mental disorders were slow to develop. There was unease expressed with ‘Western’ models of psychopathology and intervention, and there were attempts at incorporating indigenous ideas and philosophical traditions. These remained sporadic, however, and did not give rise to any pan-Indian approach to understanding psychiatric illness or its cure. Although epidemiologic rates for psychiatric disorders are lower than in high-income countries, the rates in India are higher compared to other average Asian prevalence rates. However, there have been few concerted efforts at understanding these differences and the local psychosocial factors producing psychiatric illness. Further, inadequate human resources to deal with the existing problems and serious operational problems with the National Mental Health Programme are ground realities. The growing number of private for-profit and not-for-profit mental health facilities is welcome as some have innovative mental health care reach-out strategies. However, they also remain a cause for concern due to their poor regulation and sometimes human rights violations. The new mental health policy hopefully provides a framework for better partnership, quantity and quality of care. With the re-emerging interest in global mental health and ‘universal’ treatment guidelines, it is an appropriate time for serious reflection on the way forward and to examine the relevance of local and sociocultural contexts in understanding and treating psychiatric illnesses.
Research Interests:
Research Interests: Psychology and Addiction
The authors provide an overview of the development of psychiatric services in India. They track the early developments in ancient and medieval periods, and after Western medicine made its appearance. Lunatic Asylums were established in... more
The authors provide an overview of the development of psychiatric services in India. They track the early developments in ancient and medieval periods, and after Western medicine made its appearance. Lunatic Asylums were established in India by the East India Company, and extended to various parts of the country, under British rule. The spread of medical education and services was quite slow, and there were very few psychiatrists, and a small number of beds by mid-twentieth century. Publicly funded universal health care, planned on similar lines as the NHS at the eve of Independence, did not develop sufficiently in subsequent decades. Economic and social disruption, and low priority to spending on health care thwarted efforts at extending the services. The development of pharmacological treatments in the 1950s raised the possibility of general hospital-based psychiatric services, at least of severe mental illness. Importantly, efforts to understand the psychosocial causes and correlates of both common and severe mental disorders were slow to develop. There was unease expressed with ‘Western’ models of psychopathology and intervention, and there were attempts at incorporating indigenous ideas and philosophical traditions. These remained sporadic, however, and did not give rise to any pan-Indian approach to understanding psychiatric illness or its cure. Although epidemiologic rates for psychiatric disorders are lower than in high-income countries, the rates in India are higher compared to other average Asian prevalence rates. However, there have been few concerted efforts at understanding these differences and the local psychosocial factors producing psychiatric illness. Further, inadequate human resources to deal with the existing problems and serious operational problems with the National Mental Health Programme are ground realities. The growing number of private for-profit and not-for-profit mental health facilities is welcome as some have innovative mental health care reach-out strategies. However, they also remain a cause for concern due to their poor regulation and sometimes human rights violations. The new mental health policy hopefully provides a framework for better partnership, quantity and quality of care. With the re-emerging interest in global mental health and ‘universal’ treatment guidelines, it is an appropriate time for serious reflection on the way forward and to examine the relevance of local and sociocultural contexts in understanding and treating psychiatric illnesses.