Dementia literacy and familiarity with term dementia: An exploratory study from a psychiatry outpatient setting.

Objectives: Dementia, often misperceived as an inherent facet of aging, is, in fact, a progressive neurodegenerative condition. It carries a significant stigma due to its associated psychological and behavioral manifestations, leading to neglect and abuse within households. Studies reveal an alarming 90% treatment gap for dementia in India, largely due to limited knowledge about symptom recognition and accessing services. Thus, enhancing dementia literacy becomes crucial for early diagnosis and proper management. This study aims to assess dementia literacy and familiarity with the term "dementia" in a North Indian tertiary health-care setting. Materials and Methods: This cross-sectional study used a case vignette method among patients and their attendants at psychiatry outpatient setting in a tertiary care hospital. A validated Hindi-translated case vignette depicting a dementia patient was employed. The study gathered sociodemographic data, the case vignette, and three related questions. Participants read the vignette and provided answers. The analysis included 200 responses collected in 1 month. Results: Respondents predominantly associated the case's condition with memory issues, mental illness, and psychosocial factors. They suggested social support, a nurturing family environment, communal living, and consulting a doctor for the protagonist. Familiarity with "dementia" was at a mere 24%. Conclusion: Dementia literacy and awareness of "dementia" are notably low in our sample. Urgent efforts are required to enhance dementia awareness to facilitate timely prevention, early detection, and effective management.

Consequences of medical negligence and litigations on health care providers - A narrative review.

Medical professionals face high stress due to the type of work they do and the prolonged working hours. Frequent burnout results due to the challenging nature of their work. Added to the stress of work, malpractice lawsuits add to their burden. In India, most doctors work in compromised settings with poor infrastructure and manpower but are expected to follow the best practices. In court, they are judged with the Bolam and Bolitho tests being essential considerations. Several tragic incidents have been reported, including depression, anger issues, and even suicide deaths of healthcare professionals (HCPs) after accusations of negligence and subsequent inquiry. Such incidents demonstrate the multitude of challenges an HCP faces in day-to-day practice. It is crucial to find ways to tackle these problems and enhance the capacity of HCP to handle such demanding circumstances. Malpractice litigation can significantly impact the mental health of HCPs. It is common to experience emotional turmoil when faced with a lawsuit. Second victim syndrome (SVS) is a term used to describe a set of symptoms experienced by HCPs who make an error leading to injury to a patient. However, it also happens if he is traumatized by the consequences of violence during healthcare services or a lawsuit or defamation article in newspaper/social media. Following a litigation crisis in their career, many HCPs go through various stages of grief, including shock, denial, anger, bargaining, depression, and acceptance. At times, death by suicide of the HCPs is well known. SVS is known to profoundly affect the personal, family, economic, professional (defensive practice), and social life of HCPs. HCPs should accept the allegations of negligence as an occupational hazard and prepare for the eventual litigation at least once in a lifetime by knowing about the medical laws, HCP's rights, becoming aware of the emotional turmoil of the lawsuit, preparing to cope with the lawsuit, and seeking help from colleagues and indemnity insurance. Frequent training of the HCPs is strongly recommended to know about the changing laws and also to undergo periodic professional competence enhancement to reduce the incidents of errors amounting to medical negligence. Medical and hospital administration should debrief after any incident and conduct internal investigations to identify systemic flaws and prevent future recurrence, resolve issues within their control at their level, and manage media (mainstream and social media) appropriately. If established, a reporting system with online and offline services will ease the internal administrative investigation process and take appropriate, timely actions. During the crisis, HCPs should have adequate and appropriate insurance or indemnity coverage and mental health support systems.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India.

Introduction: The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design: This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion: The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

Artificial intelligence and Psychiatry: An overview.

The burden of mental illness both in world and India is increasing at an alarming rate. Adding to it, there has been an increase in mental health challenges during covid-19 pandemic with a rise in suicide, loneliness and substance use. Artificial intelligence can act as a potential solution to address this shortage. The use of artificial intelligence is increasingly being employed in various fields of mental health like affective disorders, psychosis, and geriatric psychiatry. The benefits are various like lower costs, wider reach but at the same time it comes with its own disadvantages. This article reviews the current understanding of artificial intelligence, the types of Artificial intelligence, its current use in various mental health disorders, current status in India, advantages, disadvantages and future potentials. With the passage of time and digitalization of the modern age, there will be an increase in the use of artificial intelligence in psychiatry hence a detailed understanding will be thoughtful. For this, we searched PubMed, Google Scholar, and Science Direct, China national Knowledge Infrastructure (CNKI), Globus Index Medicus search engines by using keywords. Initial searches involved the use of each individual keyword while the later searches involved the use of more than one word in different permutation combinations.

National Medical Commission Act, 2019 - the need for parity.

The National Medical Commission (NMC) has replaced the erstwhile Medical Council of India with the intention of bringing about positive reforms in medical education and enforcing ethical standards in the practice of medicine in India. The NMC Act of 2019, under clauses 3 and 4 of Section 30, details the procedure of grievance redressal. However, these clauses in their current form empower doctors and patients unequally. While the Act empowers an aggrieved medical professional to approach the relevant appellate fora under the NMC, it is silent on a similar opportunity for an aggrieved patient or caregiver to appeal against the decision of a State Medical Council. There is a need to amend these clauses to ensure equitable opportunity for aggrieved patients to appeal against decisions of the State Medical Councils to ensure justice.

Mental health literacy and familiarity with the term schizophrenia in a community health care setting in North India.

INTRODUCTION: Mental health literacy (MHL) is an important mediator of mental health in the community. Recognition of schizophrenia by the presentation of a case vignette is often used to assess MHL. Various studies assessing MHL around the world have shown that the recognition of schizophrenia is low. This study was designed to use the case vignette method to assess the MHL in a sample of respondents in North India. METHODOLOGY: We translated a well-known case vignette of schizophrenia from english into hindi. A cross-sectional study design was followed. This case vignette was presented in the written format to 200 respondents in rural Punjab and Haryana. The case vignette was followed by questions regarding the identification and nature of the problem, what could be done about it and the familiarity of the respondent to the term 'schizophrenia'. The results were analysed through open coding. RESULTS: Around 22% of the responses identified mental illness. The recognition of schizophrenia by name was only in one response. Most people attributed the condition of the protagonist in the case vignette to be due to stressful life situations. The respondents used the terms 'depression' and 'tension' as descriptors of mental illness. The correction of situations leading to stress and counselling by a psychiatrist was considered by most respondents to be useful. The familiarity with schizophrenia was 18%. CONCLUSIONS: MHL in our sample was low. Measures for improving the MHL in the community are needed. There may be a case for easier nomenclature with regards to MHL.

COVID-19: Asymptomatic Carrier: An Autopsy Case Report.

The severe acute respiratory syndrome (SARS)-coronavirus- 2 (CoV-2) outbreak in Wuhan, China has now spread to many countries across the world including the India with an increasing death toll. On March 11, 2020, the new clinical condition COVID-19 (Corona-Virus-Disease-19) was declared a pandemic by the World Health Organization (WHO). Owing to its infectivity, high risk of transmission, and limited handling of dead bodies, published data on the course of diseases has been limited. Most patients with COVID-19 have a mild disease course and remain as asymptomatic carrier; however, few patients of older age and with co-morbidites develop severe disease leading on to fatality. If due to COVID-19 infection death occurs, an autopsy is unlikely. However in unnatural deaths the legal duty impels the proper performance of a full autopsy, to find out the cause and manner of death. The detailed autopsy examination along with histo-pathological findings in the organs of asymptomatic patient of COVID-19 and its comparison with microscopic findings in Aluminium Phosphide poisoning are discussed below. This will summarizes the research status for COVID-19 deaths, which will be important for evaluation of cause of death, prevention, control and clinical strategies of COVID-19.

A conundrum of West syndrome, behavioural problems and parental expressed emotions: a case report.

West syndrome (WS) is the most common epileptic syndrome in infancy characterised by epileptic spasms, hypsarrhythmia and neurodevelopmental problems. Epileptic spasms remain in many ways a conundrum, and the ideal intervention, as well as how to screen patients to provide optimal care and certainly its genetic cause, remains puzzling. It is important to screen infants for early recognition and intervention to achieve the optimal outcome. We hereby discuss the approach to management of a boy aged 4½ years old with WS and behavioural problems and of parental expressed emotions.

The overlap between poststroke and vascular depression: A case study.

Depression associated with cerebrovascular disease (CVD) is common among the elderly. Two major types are described, including poststroke depression (PSD), which occurs following a clinically apparent stroke and vascular depression (VaD) which results from silent cerebral infarctions or lacunar infarcts mainly in the subcortical regions. Although PSD and VaD have been regarded as distinctive types of depression, there appears to be a great degree of overlap between them. The case of an elderly patient with late-onset depression is presented to highlight this overlap.

Olanzapine-induced leucopaenia and thrombocytopaenia in an elderly patient: a case report and review of the evidence.

Haematological adverse effects of antipsychotics are rare but life threatening. Existing literature is limited to case reports, which are mostly reported on second generation antipsychotics (clozapine, olanzapine, risperidone, quetiapine). Elderly individuals are at risk of developing side effects with any psychotropics. Olanzapine is commonly used for the management of psychotic symptoms as well as for the management of behavioural and psychological problems with dementia in the elderly. In this case report, we report thrombocytopaenia and leucopaenia in an elderly individual with schizophrenia which developed after initiation of olanzapine and reverted back after stoppage of the drug. This case report highlights that the elderly are susceptible to develop haematological side effects with olanzapine and hence monitoring may be essential.