Smartphone technology provides us with a more convenient and less intrusive method of detecting c... more Smartphone technology provides us with a more convenient and less intrusive method of detecting changes in behavior and symptoms that typically precede schizophrenia relapse. To take advantage of the aforementioned, this study examines the feasibility of predicting schizophrenia relapse by identifying statistically significant anomalies in patient data gathered through mindLAMP, an open-source smartphone app. Participants, recruited in Boston, MA in the United States, and Bangalore and Bhopal in India, were invited to use mindLAMP for up to a year. The passive data (geolocation, accelerometer, and screen state), active data (surveys), and data quality metrics collected by the app were then retroactively fed into a relapse prediction model that utilizes anomaly detection. Overall, anomalies were 2.12 times more frequent in the month preceding a relapse and 2.78 times more frequent in the month preceding and following a relapse compared to intervals without relapses. The anomaly detec...
AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health probl... more 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...
IntroductionCurrently, Buprenorphine maintenance therapy (BMT) is an evidence-based treatment in ... more IntroductionCurrently, Buprenorphine maintenance therapy (BMT) is an evidence-based treatment in retaining patients who are dependent on opioids. However, factors influencing retention are often measured objectively. Studies on patient’s perspectives on take home BMT in developing countries are limited.ObjectivesThis study examines the potential factors influencing treatment compliance in the early phase of Buprenorphine maintenance treatment from the patient’s perspectiveMethodsParticipants (n=89) who were initiated on BMT were recruited and followed after six weeks. A semi-structured interview was conducted with 62 patients who remained in treatment and 24 patients who dropped out of the studyResultsBased on the semi qualitative analysis some of the factors which facilitated the patient’s retention in treatment were: (1) Effectiveness in blocking withdrawal symptoms (2) effectiveness in reducing their cravings and controlling their opioid use (3) decreased fear of withdrawal and/o...
Background The tobacco epidemic is a major health concern amplified by Covid-19. We aimed to stud... more Background The tobacco epidemic is a major health concern amplified by Covid-19. We aimed to study differences in caller profiles to the regional tobacco quitline services of South India during the Covid-19 pandemic in comparison with the prepandemic. Method Using a descriptive cross-sectional research design, we examined registered caller profiles to the quitline between March and July 2019 (Prepandemic N = 7845) and the same months in 2020 (Covid-19 pandemic phase N = 6447) phases. Results The proportion of registered callers with an expressed intent to quit tobacco increased by 1.73 times during pandemic (16.7% versus 9.6%). Health concerns were cited as the major reason (93.25%) to quit tobacco in 2020 as compared to 2019 (88.02%). Cough (28.50%) and psychological difficulties (14.20%) were reported significantly more by RCs in 2020. Self-reported quit rates were significantly higher among RCs in 2020 as compared to 2019 on the quit day (2019—47.37% & 2020—77.54%, p = .001), at ...
BackgroundDespite significant advancements in healthcare technology, digital health solutions – e... more BackgroundDespite significant advancements in healthcare technology, digital health solutions – especially those for serious mental illnesses – continue to fall short of their potential across both clinical practice and efficacy. The utility and impact of medicine, including digital medicine, hinges on relationships, trust, and engagement, particularly in the field of mental health. This paper details results from Phase 1 of a two-part study that seeks to engage people with schizophrenia, their family members, and clinicians in co-designing a digital mental health platform for use across different cultures and contexts in the United States and India.MethodsEach site interviewed a mix of clinicians, patients, and their family members in focus groups (n= 20) of two to six participants. Open-ended questions and discussions inquired about their own smartphone use and, after a demonstration of the mindLAMP platform, specific feedback on the app's utility, design, and functionality.Re...
Background Predicting and preventing relapse presents a crucial opportunity and first step to imp... more Background Predicting and preventing relapse presents a crucial opportunity and first step to improve outcomes and reduce the care gap for persons living with schizophrenia. Using commercially available smartphones and smartwatches, technology now affords opportunities to capture real-time and longitudinal profiles of patients’ symptoms, cognition, physiology and social patterns. This novel data makes it possible to explore relationships between behaviours, physiology and symptoms, which may yield personalised relapse signals. Aims Smartphone Health Assessment for Relapse Prevention (SHARP), an international mental health research study supported by the Wellcome Trust, will inform the development of a scalable and sharable digital health solution to monitor personal risk of relapse. The resulting technology will be studied toward predicting and preventing relapse among individuals diagnosed with serious mental illness. Method SHARP is a two-phase study with research sites in Boston,...
Objective The aim of this study is to give an experiential overview of a 1-year blended training ... more 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 o...
Background: Bridging the alarming treatment gap for mental disorders in India requires a monument... more 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 o...
Aim To assess the impact of COVID-19-related lockdown in India on alcohol-dependent persons. Meth... more Aim To assess the impact of COVID-19-related lockdown in India on alcohol-dependent persons. Method We examined the change in the incidence of severe alcohol withdrawal syndrome presenting to hospitals in the city of Bangalore. Results A changepoint analysis of the time series data (between 01.01.20 to 11.04.20) showed an increase in the average number of cases from 4 to 8 per day (likelihood ratio test: χ2 = 72, df = 2, P < 0.001). Conclusion An unintended consequence of the lockdown was serious illness in some patients with alcohol use disorders.
Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analge... more Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analgesic in routine clinical practice. It has reportedly low abuse potential. There are, however, a few reports of tramadol misuse among health care professionals and persons with a family history of addiction. We describe the clinical profile of three women developing addiction to tramadol. In all these cases tramadol was initially prescribed for pain by the physician. Physicians should not only prescribe tramadol cautiously and for a limited time period but also be trained in identifying misuse (self‑use, over the counter procuring, using for mind alteringproperties) and dependence (craving, withdrawal symptoms etc.).
There is a dearth of prospective trials studying treatment response in Persistent Delusional Diso... more There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our ...
Smartphone technology provides us with a more convenient and less intrusive method of detecting c... more Smartphone technology provides us with a more convenient and less intrusive method of detecting changes in behavior and symptoms that typically precede schizophrenia relapse. To take advantage of the aforementioned, this study examines the feasibility of predicting schizophrenia relapse by identifying statistically significant anomalies in patient data gathered through mindLAMP, an open-source smartphone app. Participants, recruited in Boston, MA in the United States, and Bangalore and Bhopal in India, were invited to use mindLAMP for up to a year. The passive data (geolocation, accelerometer, and screen state), active data (surveys), and data quality metrics collected by the app were then retroactively fed into a relapse prediction model that utilizes anomaly detection. Overall, anomalies were 2.12 times more frequent in the month preceding a relapse and 2.78 times more frequent in the month preceding and following a relapse compared to intervals without relapses. The anomaly detec...
AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health probl... more 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...
IntroductionCurrently, Buprenorphine maintenance therapy (BMT) is an evidence-based treatment in ... more IntroductionCurrently, Buprenorphine maintenance therapy (BMT) is an evidence-based treatment in retaining patients who are dependent on opioids. However, factors influencing retention are often measured objectively. Studies on patient’s perspectives on take home BMT in developing countries are limited.ObjectivesThis study examines the potential factors influencing treatment compliance in the early phase of Buprenorphine maintenance treatment from the patient’s perspectiveMethodsParticipants (n=89) who were initiated on BMT were recruited and followed after six weeks. A semi-structured interview was conducted with 62 patients who remained in treatment and 24 patients who dropped out of the studyResultsBased on the semi qualitative analysis some of the factors which facilitated the patient’s retention in treatment were: (1) Effectiveness in blocking withdrawal symptoms (2) effectiveness in reducing their cravings and controlling their opioid use (3) decreased fear of withdrawal and/o...
Background The tobacco epidemic is a major health concern amplified by Covid-19. We aimed to stud... more Background The tobacco epidemic is a major health concern amplified by Covid-19. We aimed to study differences in caller profiles to the regional tobacco quitline services of South India during the Covid-19 pandemic in comparison with the prepandemic. Method Using a descriptive cross-sectional research design, we examined registered caller profiles to the quitline between March and July 2019 (Prepandemic N = 7845) and the same months in 2020 (Covid-19 pandemic phase N = 6447) phases. Results The proportion of registered callers with an expressed intent to quit tobacco increased by 1.73 times during pandemic (16.7% versus 9.6%). Health concerns were cited as the major reason (93.25%) to quit tobacco in 2020 as compared to 2019 (88.02%). Cough (28.50%) and psychological difficulties (14.20%) were reported significantly more by RCs in 2020. Self-reported quit rates were significantly higher among RCs in 2020 as compared to 2019 on the quit day (2019—47.37% & 2020—77.54%, p = .001), at ...
BackgroundDespite significant advancements in healthcare technology, digital health solutions – e... more BackgroundDespite significant advancements in healthcare technology, digital health solutions – especially those for serious mental illnesses – continue to fall short of their potential across both clinical practice and efficacy. The utility and impact of medicine, including digital medicine, hinges on relationships, trust, and engagement, particularly in the field of mental health. This paper details results from Phase 1 of a two-part study that seeks to engage people with schizophrenia, their family members, and clinicians in co-designing a digital mental health platform for use across different cultures and contexts in the United States and India.MethodsEach site interviewed a mix of clinicians, patients, and their family members in focus groups (n= 20) of two to six participants. Open-ended questions and discussions inquired about their own smartphone use and, after a demonstration of the mindLAMP platform, specific feedback on the app's utility, design, and functionality.Re...
Background Predicting and preventing relapse presents a crucial opportunity and first step to imp... more Background Predicting and preventing relapse presents a crucial opportunity and first step to improve outcomes and reduce the care gap for persons living with schizophrenia. Using commercially available smartphones and smartwatches, technology now affords opportunities to capture real-time and longitudinal profiles of patients’ symptoms, cognition, physiology and social patterns. This novel data makes it possible to explore relationships between behaviours, physiology and symptoms, which may yield personalised relapse signals. Aims Smartphone Health Assessment for Relapse Prevention (SHARP), an international mental health research study supported by the Wellcome Trust, will inform the development of a scalable and sharable digital health solution to monitor personal risk of relapse. The resulting technology will be studied toward predicting and preventing relapse among individuals diagnosed with serious mental illness. Method SHARP is a two-phase study with research sites in Boston,...
Objective The aim of this study is to give an experiential overview of a 1-year blended training ... more 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 o...
Background: Bridging the alarming treatment gap for mental disorders in India requires a monument... more 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 o...
Aim To assess the impact of COVID-19-related lockdown in India on alcohol-dependent persons. Meth... more Aim To assess the impact of COVID-19-related lockdown in India on alcohol-dependent persons. Method We examined the change in the incidence of severe alcohol withdrawal syndrome presenting to hospitals in the city of Bangalore. Results A changepoint analysis of the time series data (between 01.01.20 to 11.04.20) showed an increase in the average number of cases from 4 to 8 per day (likelihood ratio test: χ2 = 72, df = 2, P < 0.001). Conclusion An unintended consequence of the lockdown was serious illness in some patients with alcohol use disorders.
Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analge... more Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analgesic in routine clinical practice. It has reportedly low abuse potential. There are, however, a few reports of tramadol misuse among health care professionals and persons with a family history of addiction. We describe the clinical profile of three women developing addiction to tramadol. In all these cases tramadol was initially prescribed for pain by the physician. Physicians should not only prescribe tramadol cautiously and for a limited time period but also be trained in identifying misuse (self‑use, over the counter procuring, using for mind alteringproperties) and dependence (craving, withdrawal symptoms etc.).
There is a dearth of prospective trials studying treatment response in Persistent Delusional Diso... more There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our ...
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