Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India.

Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.

Work-life balance among mental health professionals in a tertiary care neuropsychiatry centre in India.

Background: Stress and distress are common among Mental Health Professionals (MHP). MHPs avoid seeking professional help to address their stress, leading to increased vulnerability to stress and mental health conditions. Inadequately addressed stress directly impacts their service delivery and well-being. However, a serious dearth of literature from India has examined the extent of work-life balance (WLB) stress and psychological distress (PD) among MHP. Aim: This cross-sectional study aims to assess WLB and examine the relationship between perceived stress (PS), PD, burnout, and WLB among MHP in a tertiary care neuropsychiatry center. Methods: Using stratified random sampling, 101 MHP were evaluated using Pareek's work-life balance scale, Stamm's professional quality of life (ProQoL) scale, WHO's self-reporting questionnaire, and Cohen's perceived stress scale. Data were analyzed using appropriate parametric or non-parametric tests. Results: The overall mean score on WLB was 80.45 (SD = 10.21), the PS scale was 24.86 (SD = 6.87), the burnout score was 22.68 (SD = 6), the ST score was 21.18 (SD = 6.35), and PD score was 5.07 (SD = 5.23). The level of WLB score was average to below average among 64% of participants. There is a positive correlation between WLB and compassion satisfaction (CS) and a negative correlation between ST and PS. The study found that the nature of the job, CS, and PD shall predict WLB. Conclusion: Stress, burnout, ProQoL, and WLB of MHPs vary significantly by job, income, and staying with family, indicating that MHPs are equally vulnerable to stress and burnout and imbalanced WLB, which require appropriate interventions.

The Psychiatrist as an Expert Witness.

A psychiatrist, in India, unlike in the western developed world often is required to play dual role of being a treating psychiatrist and that of an expert witness for the same patient. In the clinical scenario, the principle of therapeutic alliance comes into play, while in the court of law, he/she needs to play the role of assisting the judicial system to deliver "justice." Psychiatrist role in the court is directed by the court rules and not by the clinical rules. This chapter aims to describe the various roles played by the psychiatrist in the court room and provides a basic outline of the medicolegal expectations from a psychiatrist.

Functional near-infrared spectroscopy in schizophrenia patients with auditory verbal hallucinations: Preliminary observations.

Auditory Signal Detection (ASD) theory postulates that auditory verbal hallucinations (AVH) result from an aberrant association of meaningful connection to abstract noises. In this study, schizophrenia (SZ) patients with persistent AVH (N = 17) and matched controls (N = 25) performed an ASD task with concurrent functional near-infrared spectroscopy recording targetting the left dorsolateral prefrontal cortex (L-DLPFC) and left temporoparietal junction (L-TPJ). During the task, discriminability index had a significant negative correlation, and early deoxyhemoglobin (HbR) latency at L-TPJ positively correlated with AVH scores. Also, patients had significantly lower discriminability, early HbR latency at L-TPJ, and delayed latency at L-DLPFC. This finding suggests the presence of ASD abnormalities and impaired auditory processing in SZ patients with AVH supporting ASD-based pathogenesis.

Grounded theory of 'lifestyle adaptation' - Perspectives from persons with schizophrenia and their caregivers.

INTRODUCTION: Available evidence highlights that persons diagnosed with schizophrenia are predisposed to develop physical co-morbidities. Lifestyle modification interventions are identified as appropriate strategies to maintain their physical health. A comprehensive understanding of the facilitators and barriers in adhering to healthy lifestyle interventions is critical to developing individualized interventions that are effective and accessible for these patients. AIM: To develop and formulate a theory of lifestyle adaptation for the prevention of physical co-morbidities for persons with schizophrenia and their caregivers who are availing mental health services in the psychiatry wards. MATERIALS AND METHODS: The qualitative data were collected by semi-structured interviews using topic guides from persons with schizophrenia and their family caregivers from the tertiary level psychiatry center, South India. The interviews explored their perceptions and experiences of the facilitators and barriers in adopting a healthy lifestyle. Final data was analyzed based on grounded theory, and the data was used to formulate the theory of lifestyle adaptation. CONCLUSION: The persons with schizophrenia and their family caregivers' perceptions helped in formulating this theory. The present study provides recommendations for physical health services for patients with mental illness. The findings of the study may guide health professionals and mental health advocacy groups, policymakers to plan for appropriate decisions related to incorporating mental health care with physical health care services.

Addressing the mental health concerns of migrant workers during the COVID-19 pandemic: An experiential account.

The COVID pandemic has affected the world in a drastic manner taking a toll of not only human lives but also the economy and lifestyle. Of all the population suffering, the underprivileged and vulnerable groups have faced the maximum economic burden. Within India, an ample quota of people migrates annually for elementary occupations in service, sales, building and domestic industries. Generally, they are exposed to discrimination, work-rights exploitation and job insecurity. The onset of COVID 19 has accentuated these issues in unprecedented ways. The Apex Court of the country took note of this plight and gave directions to the governments to take care of the immediate needs of the migrant workers. This article attempts to reflect the mental health concerns of the migrant workers who were temporarily sheltered at relief camps across Bengaluru city in the state of Karnataka, during the ongoing COVID pandemic. The article ends with giving recommendations.

Do Indian patients with schizophrenia need half the recommended clozapine dose to achieve therapeutic serum level? An exploratory study.

Inter-racial differences in serum clozapine have received less scientific importance, as there are fewer studies on therapeutic drug monitoring (TDM) from Asia. We measured the serum clozapine levels in 142 patients with schizophrenia and related disorders at a tertiary care psychiatric institute in India. The clozapine concentration per milligram (mg) of oral clozapine dose (C/D ratio) was calculated, and the C/D ratio was used to estimate oral clozapine dose needed to achieve therapeutic serum clozapine level (350 ng/ml). This study examined Indian patients only and compared the results with weighted mean serum clozapine and its correlates in Caucasian population, based on published scientific literature. The median C/D ratio in our sample was 2.5 (n = 142), and the clozapine dose needed to achieve therapeutic serum clozapine level was 140 mg/d. The median C/D ratio of our subjects was nearly two and a half times higher than the weighted mean C/D ratio of Caucasians (2.5 v/s 1.07) reported elsewhere. After excluding the significant pharmacokinetic interactions and stratifying according to gender and smoking status, the estimated clozapine dose to achieve therapeutic serum level in male smokers (n = 9) and female non-smokers (n = 38) were 238 mg/d (C/D ratio; 1.47) and 120 mg/d (C/D ratio:2.93) respectively. On comparing, male smokers (600 mg/d versus 238 mg/d) and female non-smokers (300 mg/d versus 120 mg/d) in our study needed about 40% of the recommended clozapine dose for Caucasians to achieve therapeutic serum clozapine level. The pharmacogenetic correlates of lesser clozapine dose requirement in the Indian population require further research.

Effect of music listening on P300 event-related potential in patients with schizophrenia: A pilot study.

Reduced amplitude and increased latency of P300 auditory event-related potential (ERP) in patients with schizophrenia (SZ) indicate impairment in attention. Overall arousal level can determine the amount of processing capacity required for attention allocation. Music evokes strong emotions and regulates arousability. Music has been used to modulate P300, especially in normals. This exploratory study examined the effect of music listening on the amplitude and latency of P300 in SZ patients. EEG/ERP was recorded (32-channels) while SZ patients (n = 20; 18-45 years) performed an auditory oddball P300 task after the eyes-closed rest condition (Condition-A) and ten-minute music listening condition (Condition-B) as per the complete counterbalancing design (AB-BA). Patients listened to the researcher chosen, instrumental presentation of raag-Bhoopali in the North-Indian-Classical-Music, for ten-minutes. All patients rated the music excerpt as a relaxing and positively valenced. A significant increase in accuracy score and reaction time during the oddball task after music listening was noted. There was an increase in amplitude at TP7. A trend of increased amplitude was noted across all electrodes in the music condition compared to the rest condition. Mean amplitude in an apriori defined time window of interest (250 to 750 ms) showed significant changes in the frontal and central electrode sites. Power spectral analysis indicated a slight increase in frontal and central alpha and theta activity during music listening. However, this was not statistically significant. Findings add further impetus to examine the effect of music in chronic psychiatric conditions. Need for systematic studies on a larger cohort is underscored.

Healthy lifestyle behavior and personal control in people with schizophrenia with healthy controls: A cross-sectional comparative study.

The aim of the article was to compare persons with schizophrenia and healthy controls about their life style on their physical health and personal control. Evidences highlights that it helps to change risk behaviours associated with co morbid physical health problems. Subjects were recruited from adult mental health services in tertiary level psychiatric center.Comparisons between the groups were done by using the lifestyle and personal control questionnaire. Subjects were 86 with schizophrenia, 72 were healthy controls. Results showed significant difference. However, physical health was considered to be a less important priority in their personal life by persons with schizophrenia.

Facilitators of healthy life style behaviors in persons with schizophrenia-A qualitative feasibility pilot study.

INTRODUCTION: Persons with schizophrenia experience high rates of cardio metabolic disorders and have a 20-25% shorter life expectancy than the general population. Health professionals led life style modification behavior programs have shown improvements, in managing aspects of metabolic problems. This study sought to identify the life style modification by exploring (1) facilitators that help persons with schizophrenia to adopt the lifestyle modification behaviors and (2) factors that help to adhere to life style modification behaviors. METHODS: A qualitative study utilizing face to face interviews was conducted for five persons (n = 5) diagnosed as schizophrenia (ICD 10) and their caregivers (n = 13) receiving inpatient mental health services in a tertiary level psychiatry centre, in South India. Qualitative data was collected, organized and analyzed with thematic analysis using ATLAS.ti software. RESULTS: The study results identified four major themes as facilitators. (1) Factors of increased self- confidence, and personal development. (2) The need for social support and conducive environment; (3) level of self motivation (4) encouragement from health professional and availability of health services. Participants believed that engaging with programs of physical activity, dietary modification, and illness support from family would motivate them to live more healthily. CONCLUSION: Individuals with serious mental illnesses such as schizophrenia encounter physical health related problems, facilitators of lifestyle change behavior help them to adhere to change in their routine life. Lifestyle change interventions also motivate individuals to eat healthy diet and exercise regularly to prevent premature mortality.

Exercise, diet and educational interventions for metabolic syndrome in persons with schizophrenia: A systematic review.

INTRODUCTION: Individuals with major psychotic disorders such as schizophrenia are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous interventions have been tested in inpatient and outpatient mental health settings to decrease risk factors. Diet and exercise represent the mainstay of weight loss treatment. With this background the review aimed to evaluate the effects of psychoeducation, diet and physical activity interventions on reduction of metabolic syndrome risk factors such as BMI, Body weight, biochemical profiles in schizophrenia. METHODS: The authors conducted database searches of PsychINFO, MEDLINE, Pubmed, Proquest, EBSCO and the Cochrane Database of Systematic Reviews, and manual searches from 1968 to 2017. Search indentified 11 studies that met the inclusion criteria. Study quality was critically appraised by 2 reviewers using established criteria. The outcome measures were body mass index, body weight, waist circumference, lipid profile, fasting glucose. RESULTS: Interventions led to significant weight reduction (8 studies), reduced body mass index (5 studies), decreased waist circumference (4 studies) and lower blood glucose levels (5 studies). Dietician and nurse led interventions (6 studies). The studies showed non pharmacological interventions were effective in reducing risk factors. CONCLUSION: This review was able to demonstrate effectiveness of peychoeducation, diet and physical activity interventions were helpful to decrease and manage antipsychotic-induced weight gain. Results showed lifestyle interventions are safer and effective for promoting decrease or maintenance of weight and it can be delivered at low cost, safe and improves quality of life.

Feasibility of Online Neuromodulation Using Transcranial Alternating Current Stimulation in Schizophrenia.

Abnormalities in resting and event-related brain oscillations are known to be associated with cognitive deficits in schizophrenia. Transcranial alternating current stimulation (tACS) modulates these rhythms across the neuronal circuits and could have a potential therapeutic role in psychiatric disorders. In this report, we describe, for the first time, application of online tACS in a schizophrenia patient with working memory deficits. This case report supports the feasibility and potential utility of online tACS in schizophrenia, which needs further systematic research.