In India, 85% of healthcare occurs in the private sector. Health insurance schemes can help prevent catastrophic health expenditure and resultant “poverty trap.” Section 21 (4) of the Mental Health Care Act (MHCA) 2017 asks insurers to make provisions for treating mental illness on the same basis as is available for the treatment of physical illness. The Insurance Regulatory and Development Authority of India has required health insurance companies to comply with MHCA 2017. This paper discusses various health insurance policies available for mental health conditions and implications of a recent Delhi high court verdict for health insurance for mental illness.
Weight gain is common in patients with severe mental illness and contributes to cardiovascular risk. Medications, such as antipsychotics, antidepressants, and mood stabilizers, are commonly associated with weight gain. In addition, antidiabetic drugs (insulin, sulfonylureas, and thiazolidinediones), antihypertensives (beta-blockers), and corticosteroids, which are commonly used to treat comorbid medical conditions, contribute to weight gain. In clinical practice, simple measures, such as body weight, body mass index, and waist circumference, can be used to monitor the metabolic risk of psychotropic drugs. Lifestyle modifications, including dietary advice and exercise, help in preventing weight gain. The clinician can choose relatively weight-neutral drugs for the treatment of psychiatric disorders. For the patients having weight gain with psychotropic drugs, several nonpharmacological and pharmacological management strategies are available.
Background: Benefits of buprenorphine-based opioid substitution therapy (OST) may be offset by its adverse effects on sexual functioning.
Aim and objective: The aim of the article was to assess the prevalence and degrees of sexual dysfunction in sexually active males on buprenorphine-based OST for 6 months or longer.
Materials and methods: Study participants were recruited from among the clients using the services at the Opioid Substitution Therapy Centre inside the premises of Silchar Medical College and Hospital. A semistructured questionnaire was used to collect sociodemographic data and to rule out the presence of symptoms of sexual dysfunction prior to initiation of OST. Two instruments, namely Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function (IIEF-15), were administered to evaluate the presence and degree of sexual dysfunction.
Results: Fifty participants were enrolled in the test group and another 50 in the age-matched control group. Among the test participants, 52% had sexual dysfunction as per ASEX scale. As per IIEF-15, all but one of the test participants had some degree of erectile dysfunction (ED), with 6% having mild, 46% mild to moderate, 34% moderate, and 12% severe ED. None in the control group had sexual dysfunction as assessed by ASEX, while one among them had mild ED and the rest had no ED as per IIEF-15 scores. The test group showed significantly higher levels of dysfunction in all domains of sexual functioning measured by both the scales. No significant effect of age, current dose of buprenorphine, and duration of therapy was found on the prevalence or degree of sexual dysfunction.
Conclusion: Different degrees of sexual dysfunction were highly prevalent in the participants making it imperative to routinely assess sexual functioning of the clients on buprenorphine-based OST and provide them with psychosexual counseling and necessary interventions whenever necessary.
Alcohol dependence, Attention deficit hyperactivity disorder, Severe dependence
DOI: 10.5005/jp-journals-10067-0075 |
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Venkatakrishna S. Adult Attention Deficit Hyperactivity Disorder and Its Correlates with the Presence and Severity of Early-onset Alcohol Dependence: An Estimate from a Tertiary Care Center. Ind J Priv Psychiatry 2021; 15 (1):23-26.
Background: Alcohol dependence is a highly prevalent condition worldwide. Among those with early-onset substance dependence, studies have found that about 30% have comorbid attention deficit hyperactivity disorder (ADHD). Such patients tend to have severe dependence, poorer outcomes, and failure of classical treatment.
Aim and objective: To study the prevalence of adult ADHD and explore the correlates of ADHD among those with early-onset alcohol dependence.
Materials and methods: Eighty-two adult inpatients with early-onset alcohol dependence were recruited for the study after obtaining informed consent. The World Health Organization (WHO) Adult ADHD Screening Rating Scale (ASRS) was used to screen adult ADHD. Wender Utah Rating Scale (WURS) was used to corroborate childhood ADHD symptoms. Severity of Alcohol Dependence Questionnaire (SAD-Q) was administered to determine the severity of dependence. Cohen's Perceived Stress Scale was administered to determine the perceived stress levels in the past 1 month. MINI Plus Neuropsychiatric Interview was administered to rule out mood disorders and antisocial personality disorder (ASPD). Analysis of data was done using t-test, Fisher's exact test, Spearman's correlations, and multiple logistic regression analysis to determine the odds of having severe dependence.
Results: Twenty-one out of the 82 subjects with early-onset alcohol dependence had adult ADHD (25.6%). The severity of alcohol dependence was significantly greater among those with comorbid ADHD (p <0.001). The odds of having ADHD predicting severe dependence was 8 (p = 0.0004).
Conclusion: The prevalence of adult ADHD in those with early-onset alcohol dependence is high. Adult ADHD is a significant predictor of greater severity of alcohol dependence. There is a need for studies that evaluate therapeutic options that would be effective for the treatment of comorbid ADHD and early-onset alcohol dependence.
Background: Suicides among psychiatric patients are common. Most of the psychiatrists during their professional life will see at least one patient of theirs committing suicide. It can have distressing effects on them.
Aim and objective: To find the personal and professional details of psychiatrists, suicides of patients under their care, and their effects.
Design: Contacting randomized representative sample of psychiatrists active in clinical patient care by online and offline communication methods.
Participants: Representative sample of 143 psychiatric postgraduates (PGs) and psychiatrists in India, who are in active practice of the profession.
Main outcome measures: Personal and professional details of psychiatrists, and details of the suicide of the patient under their care, effects, and coping mechanisms.
Results: Out of a total of 143 responses—62% of male and 38% of female—29.4% of responders reported at least one patient under their treatment committing suicide, with an average of 12.8% of suicides for psychiatrists having such experience. Senior psychiatrists were overrepresented by age-wise and experience-wise. The commonest diagnosis was depression, and the method adopted was hanging. Suicide of the patient under treatment affected 40.5% of treating psychiatrists in both personal and professional life. And 26.2% had no impact on either personal or professional life; 33.3% of responders reported that the suicide of the patient had an impact on either personal or professional life. Most of them felt the suicide was predictable, preventable, and the training they had was adequate. More than half were apprehensive about litigation. Due to the suicide of patients, six psychiatrists considered taking early retirement.
Conclusion: There is a need for preparing newer and younger psychiatrists to face the ordeal of the patient under treatment committing suicide.
Background: Even though attempted suicides represent the “tip of the iceberg,” they are slowly assuming the levels of a public health problem caused by several factors. We aimed to study the various clinical characteristics and gender differences among suicidal attempters.
Methods: A hospital-based cross-sectional study was conducted after taking ethical clearance. Data were collected from a tertiary care center at Bagalkot over the 6 months. The subjects who fulfilled the inclusion and exclusion criteria were evaluated by using semistructured pro forma, and various scales like Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), and Beck's Suicide Intent Scale (SIS) were applied. Relevant statistical tests were performed.
Results: Total number of study participants was 100 out of which 52% were females and 48% were males. The mean age of suicide attempters was 29.08 (SD = 11.601). Organophosphorus poisoning was the mode of attempt in 33% of the study subjects and 26% had severe depression.
Conclusion: Factors responsible for attempted suicides were young adults, female sex, low socioeconomic status, low education level, with marriage also being a potential one. Depression and anxiety are the psychiatric disorders associated strongly with a suicide attempt. Most of these factors can be either prevented or controlled.
Autism spectrum disorder, Comorbidities, Intellectual disability, Behavioral problem
DOI: 10.5005/jp-journals-10067-0080 |
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Venkatakrishna S, Ruth S, Nanjappa VB. A Cross-sectional Study of Prevalence of Autism Spectrum Disorder among Children Referred for the Assessment of Intellectual Disability for Certification and Its Association with Behavioral and Medical Issues. Ind J Priv Psychiatry 2021; 15 (1):38-41.
Introduction: Intellectual disability (ID) is one of the strongest predictors of outcomes for those with autism spectrum disorder (ASD). Behavioral problems that are commonly observed in autism may be related to the core features of ASD or comorbid diagnoses.
Aims: To assess the prevalence of ASD in those with ID referred for disability assessment and the associated medical and psychological comorbid issues.
Materials and methods: The present study was a cross-sectional study that included 133 children with mild or moderate ID between 6 and 18 years of age. The study tools used were Indian Scale for Assessment of Autism (ISAA), Behavior Problems Inventory (BPI), and a questionnaire to assess medical symptoms.
Results: The prevalence of comorbid ASD in children with ID was 16.39%. Individuals with ASD had higher behavioral problems (p = 0.001) and medical issues that included gastrointestinal (GI) symptoms (constipation, p = 0.001; bloating, p = 0.03; and abdominal pain, p = 0.03) and seizure (p = 0.002). Children with severe ASD scores had higher behavioral problem scores.
Conclusion: Individuals with ID who were referred for disability assessment had a significant prevalence of ASD. These children had higher behavioral problems and medical issues. It is thus important to screen for ASD in individuals with ID for better management of these individuals.
DOI: 10.5005/jp-journals-10067-0069 |
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Motwani S, Murlimanohar K. Cranial Electrotherapy Stimulation in Patients Suffering from Medically Unexplained Somatic Symptoms: A Case Series. Ind J Priv Psychiatry 2021; 15 (1):42-44.
Introduction: Patients with medically unexplained somatic symptoms (MUSS) are encountered commonly in clinical practice. These symptoms are often difficult to treat and do not respond well to medication. There have been some studies demonstrating the efficacy of cranial electrotherapy stimulation (CES) in the management of somatic symptoms. Most studies on CES are for the management of anxiety and there is a dearth of literature with regard to the use of CES in MUSS. This case series is aimed at demonstrating the efficacy of CES in the management of MUSS.
Methods: This case series consisted of patients with MUSS that presented to the psychiatry outpatient department of a tertiary general hospital. Patients with MUSS with no other medical cause and not relieved with available medications were included in the case series. Patients were administered CES daily for 10–20 sessions with each session lasting 30 minutes. The efficacy was evaluated by applying Somatic Symptom Scale-8(SSS-8)and the results of all cases were analyzed.
Results: Thirty-five patients (26 females and 9 males) between the ages 18–66 years were part of the case series. Majority of them had a diagnosis of major depressive disorder. There was statistically significant improvement in somatic symptoms after CES sessions in majority of the patients at the end of day 20 (29 of 35 patients).
Conclusions: CES is a safe treatment option for MUSS, and further studies in larger samples to establish its efficacy is warranted.
Mental illness and homelessness are interlinked and constitute a vicious circle. Persons who are suffering from mental illness may get separated from their families because of their psychopathology or cognitive distortion. Sometimes they may not be able to recall their names and family residential address and wander away to faraway places. Being part of society is the key to having the important things in life that everyone wants. A person who is suffering from schizophrenia or other psychotic disorder also needs good health, relationships, food, shelter, and employment. With the help of new technology, like Google maps, and Aadhaar fingerprint, we can decrease the time spent for tracing the families of persons with mental illness and reintegrate the patients with their family members. Here, through this case study, an attempt has been made to discuss the efforts made and challenges faced concerning the reintegration of mentally ill persons with a special focus on enhancing social networks by using newer technology.
Charles Bonnet syndrome (CBS) is a common occurrence of visual hallucinations in the elderly with visual impairment. It is generally benign and is managed supportively and non-pharmacologically with interventions to restore vision. In its atypical form, it also has hallucinations in other modalities. We report here a case of atypical CBS in a 56-year-old man with bilateral vision loss due to an old injury in one eye and the mature cataract in another eye. The patient responded well to olanzapine.
Many journals and other published guidelines provide large, sometimes strict instructions to be included for becoming eligible in academic journals. However, there is a lack of simple and clear recommendations on how to write such scientific articles. We propose a simple and easy-to-follow hypothesis-based approach. The introduction section should start by introducing the relevant concepts, formulate the study hypothesis, mention the gap in knowledge in the existing literature, and describing the study hypothesis in simple language at the end. The material and methods section must describe the study design, sample or material, the tools, instruments, inclusion and exclusion criteria, and procedures used to test the study hypothesis. The results section must describe the data analyses that lead to the confirmation or rejection of the hypothesis. The discussion must state whether the study hypothesis has been confirmed or rejected and compare the study result with previous research. It should clarify the limitations of the study and explore the relevance of the study findings for clinical practice and future research. An abstract at the beginning of the manuscript, usually structured with objectives, material and methods, results and conclusion, should be added. Acknowledgments, ethical approval, informed consent by study subjects, conflicts of interests by authors, and a reference list will be needed in most scientific journals.
Palanimuthu Thangaraju Sivakumar,
Channaveerachari Naveen Kumar,
Suresh Bada Math