Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant Obsessive-Compulsive Disorder: Résultats à long terme de soins intensifs à des patients hospitalisés pour un trouble obsessionnel-compulsif grave et résistant.

OBJECTIVE: A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT. METHODS: A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded. RESULTS: At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen's d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include "remitters" (14.5%), "responders" (36.5%), "minimal responders" (34.7%), and "nonresponders" (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up. CONCLUSION: Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.

Assessing Adult ADHD: An Updated Review of Rating Scales for Adult Attention Deficit Hyperactivity Disorder (ADHD).

METHOD: Scholarly articles on adult ADHD between 1996 and 2022 were reviewed using the PRISMA guidelines. ADHD rating scales with multiple citations were selected and their psychometric properties and symptom coverage were analyzed. RESULTS: Ten rating scales, with sound psychometric properties, were identified. Out of those reviewed two (BADDS and BAARS-IV) load on the inattentive domain of ADHD, while the rest focus on a comprehensive assessment of ADHD. Only one scale (BARRS-IV) incorporates an assessment of functional impairment. Some scales though widely utilized have not been adequately examined for their sensitivity. CONCLUSIONS: Rating scales are reliable and valid, in the assessment of adult ADHD. We present a review of recent scales, with an expanded focus, to help clinicians make informed decisions on diagnosis, identifying targets and planning interventions accordingly.

Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting.

OBJECTIVE: We examined the unique predictive strength of anxiety sensitivity (AS) and the role of expectancy, credibility, and therapeutic alliance (TA) as predictors and mediators of cognitive-behavioral treatment (CBT) outcomes in obsessive-compulsive disorder (OCD). METHOD: The current study is a prospective cohort study. Participants (N = 116) were treatment-seeking individuals with a primary diagnosis of OCD. Independent raters assessed patients on Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Anxiety Sensitivity Index-3 at baseline, post-intervention, and three-month follow-up. Participants responded to the Credibility and Expectancy questionnaire and Working Alliance Inventory-Short revised at baseline, first-session, and mid-session. RESULTS: The individual addition of AS, end-of-first-session credibility and expectancy, mid-session credibility and expectancy, and therapeutic alliance predicted significant CBT outcomes. There was a moderate positive correlation between baseline OCD severity and the global score of AS, but a weak one with AS dimensions. Both expectancy and credibility significantly improved from baseline to end-of-first-session treatment. End-of-first and third-session outcome expectancies, not credibility, have significant, indirect effects on OCD CBT outcomes. CONCLUSIONS: AS, within-session credibility and expectancies and TA independently predict CBT outcomes. Within-sessions outcome expectancies mediate CBT outcomes in OCD, not credibility. Expectancy and credibility both include state-like elements that can be influenced to enhance the outcomes of CBT. Proposals for reducing treatment barriers in CBT for OCD are offered.

Effectiveness of multi-disciplinary structured training program on mentoring and mental well-being for officers and instructors in the Indian Air Force.

Background: The military environment is characterized by unpredictable situations, intensive training, demanding workload, and job-associated stressors, which make it highly stressful. Mentorship and mental well-being training could be beneficial to both officers and the new adolescent recruits of the Indian Air Force (IAF). Aim: This study aimed at evaluating the effect of a multi-disciplinary structured training on mentoring and mental well-being among officers and instructors in the IAF. Methods: Seventy IAF officers/instructors underwent a week-long multi-disciplinary structured training program, which was conducted at a tertiary care neuro-psychiatric hospital in South India. A quasi-experimental design with a single-group pre- and post-test was adopted. Outcome measures included a) knowledge on mentorship and mental health and b) self-perceived competence in addressing mental health distress. Results: Post training, there was a statistically significant improvement in scores on mentorship/mental health knowledge and a significant increase in self-perceived competence in addressing mental distress. Conclusion: Mentorship and mental well-being training for officers and instructors in the IAF improved mental health knowledge and self-perceived competence. Therefore, administration of regular and in-depth structured mental health-related training interventions could be beneficial not only to the officers but also to the new recruits/mentees in the IAF.

Pathways to mental health consultations: A study from a tertiary care setting in India.

BACKGROUND: Research indicates that help seeking for mental health is low and often delayed. Understanding pathways to care is crucial to facilitate mental health referrals and reduce the time to consultation. METHODS: In the present study, 63 individuals were assessed on illness severity, attitudes towards help-seeking and pathways-to-care. RESULTS: Multiple pathways for therapy were noted, a delayed-pathway, two-step referral pathway and a direct-pathway. Most prominent pathway was the delayed-pathway. The direct-pathway had least treatment delay, contributed by timely recognition of symptoms by the patient. As first point of contact, patients preferred psychiatrists and popularly sought information about treatment via media. CONCLUSIONS: There are multiple pathways to consultations, often leading to treatment delay in care received. Timely recognition of symptoms was associated a direct pathway and the least delay. These findings have implications for strengthening routes to mental health specialists at early stages and increasing awareness about treatment available.

Maximizing the non-specific factors in brief cognitive behavioral therapy for panic disorder and agoraphobia: A multiple baseline case series documenting feasibility and initial efficacy.

There is evidence for non-specific factors impacting treatment outcomes, with pragmatic concerns regarding the need to popularize briefer formats of cognitive behavioral therapy (CBT). The need to have more culturally suitable and acceptable forms of CBT is also indicated. We evaluated the feasibility and efficacy of a brief 5 session CBT (bCBT) in participants (N = 4) with panic disorder (PD) and agoraphobia, using a non-concurrent multiple baseline design. In this case series, efforts were made to maximize non-specific factors of psychotherapy in bringing about treatment outcomes. Reliable and significant treatment effects were observed at post-intervention and follow-up assessments. The present study offers preliminary evidence of a bCBT protocol that comprises the efforts to maximize the non-specific factors in psychotherapy such as credibility, expectancy, and the therapeutic alliance in bringing treatment outcomes; however, further controlled evaluation is warranted. We also discuss the mechanisms contributing to these treatment outcomes in the present protocol.

Client perspectives on perceived barriers to homework adherence in psychotherapy: An exploratory study from India.

We explored perceived barriers to homework adherence in clients receiving individual psychotherapy. Ninety-four adults with at least four individual psychotherapy sessions were recruited from outpatient services of a tertiary hospital in India and assessed on the Barriers to CBT Homework Completion Scale, Homework Compliance Scale, and Clinical Global Impressions scale. More than one-fourth completed some portion of the homework. Participants reported a high level of overall perceived barriers to homework, with more task-and-patient related factors. Higher perceived barriers were associated with lower adherence. Findings highlight the importance of understanding perceived barriers to homework adherence and addressing them systematically.

Design and development of a training video for Accredited Social Health Activists (ASHAs) on brief psychological intervention for depression.

Background: Depression poses a major public health burden and has a large treatment gap in India. The study attempts to address this treatment gap by developing a training video for Accredited Social Health Activists (ASHAs), who are community health workers, on brief psychological intervention for depression. Methods: The systematic steps utilized in the design and development of the training video on depression were: 1) Content development of the video script and training booklet for ASHAs based on the review of research literature and two Focus Group Discussions, 2) Mental Health Professionals' evaluation of the video script and training booklet for ASHAs, 3) Translation from English to Kannada, 4) ASHAs' evaluation of the video script and training booklet for ASHAs, 5) Conversion of the video script into a 'shooting script', 6) Video production, 7) Evaluation of the training video, 8) Post-production of the training video, and 9) Development of the training guide. Results: The training video titled "Light of Hope: A Training Video on Depression" was developed along with two training booklets, which are complementary resource materials, for ASHAs and the training Facilitators. The brief psychological intervention for depression elucidated in the training video incorporates the evidence-based strategies of Psychoeducation, Activity Scheduling, Problem-Solving Skills Training, and Diaphragmatic/Abdominal Breathing Skills Training. Conclusion: The study demonstrates the systematic approach that can be employed for the design and development of a mental health training video, which has evidence-based content, incorporates stakeholders' evaluative perspectives, and is culturally contextualized.

Mental health orientation among ASHAs: A study from Karnataka State, India.

INTRODUCTION: The high mental health treatment gap in India, necessitates mental health service delivery through the primary health care system. Accredited Social Health Activists (ASHAs) as frontline community health workers are a key member of the primary health care team. The ASHAs training needs related to mental health, require to be determined in order to accordingly tailor capacity-building programs. In this context, the present study aims to examine the ASHAs mental health orientation utilizing a factorially validated Indian tool. METHODS: In this cross-sectional study, 91 ASHAs from a taluk of Bengaluru Urban District, responded to the self-administered Orientation towards Mental Illness (OMI) scale. Data were analysed using descriptive statistics viz. frequencies, percentages, means, and standard deviations. RESULTS: The ASHAs reported an overall unfavourable mental health orientation and the specific OMI factors on which unfavourable orientation was observed were Psychosocial stress, Non-restrained behaviour, Weak cognitive control, Fidgety behaviour, Bizarre behaviour, Psychosocial manipulation, and Hypo-functioning. CONCLUSION: The findings of the study suggest that capacity-building programs for ASHAs will need to first examine their orientation to mental health and collaboratively address an unfavourable orientation when present, as it would have a bearing on ASHAs mental health service delivery in the community.

Psychological preparedness for pandemic (COVID-19) management: Perceptions of nurses and nursing students in India.

INTRODUCTION: The growing COVID-19 pandemic has posed a great threat to millions of people worldwide. Nurses and nursing students are an important group of health professionals who are most likely to face many challenges in this unprecedented scenario. The present study aimed at exploring nurses' and nursing students' perception of psychological preparedness for the pandemic (COVID-19) management. MATERIALS & METHODS: The study employed a quantitative cross-sectional online survey research design. Purposive sampling was used with an attempt to represent the entire nurses (i.e. nursing officers, nurse administrators and nursing teachers) and nursing students' group of India. The survey link including the questionnaires was shared to their email ID and they were invited to participate in the study. Data were collected using Psychological Preparedness for Disaster Threat Scale (PPDTS)-Modified, General Self Efficacy (GSE) Scale, Optimism Scale and Brief Resilient Coping Scale (BRS). Totally 685 responses were received and 676 forms were completed which were analyzed using SPSS software (version 24). RESULTS: The mean age of the subjects was 31.72±9.58 years. Around 20% of the subjects previously had some kind of psychological training and 4% of the subjects had taken care of persons with COVID-19. Findings revealed that mean score for PPDTS, GSE, BRCS and Optimism was 73.44±10.82, 33.19±5.23, 16.79±2.73 and 9.61±2.26 respectively indicating that the subjects had moderate level of psychological preparedness, self-efficacy and resilience but higher level of optimism. Psychological preparedness, self-efficacy, optimism and resilience were positively correlated to each other. Self- efficacy, optimism, and resilience emerged as predictors of psychological preparedness. CONCLUSION: The findings suggested that self-efficacy, optimism and resilience can be considered as predictors for psychological preparedness in pandemic management. Appropriate training could influence self-efficacy while programs addressing resilience and coping may strengthen psychological preparedness which can help in further management of ongoing pandemic.

Illness perceptions and health beliefs in persons with common mental disorders.

INTRODUCTION: Help seeking is crucial in the context of illness management and care. Various psychological factors impact this process of help-seeking. In this background, the present study explored illness perceptions, attitudes to help-seeking, work and social adjustment in addition to clinical correlates, in a sample of 63 treatment seeking individuals. METHODS: The study adopted a cross-sectional single group design. Participants were assessed on the Brief Illness Perception Questionnaire, Attitudes Toward Seeking Professional Psychological Help Scale, General Self-efficacy Scale, Internalized Stigma and Work and Social Adjustment Scale. RESULTS: Majority had illness duration of about 6 years and had delayed seeking treatment for about one and half years. Participants reported higher emotional reactions to illness, concerns regarding effectiveness of treatment and understanding and meaning about illness on the BIPQ. Illness perceptions were significantly correlated with work and social adjustment and attitudes toward seeking professional psychological help. General self- efficacy and internalized stigma emerged as predictors of overall work and social adjustment. CONCLUSIONS: The study has implications for interventions that need to target beliefs about illness in order to maximize help-seeking and reduce treatment gap.

Efficacy of a Brief Self-management Intervention in Type 2 Diabetes Mellitus: A Randomized Controlled Trial from India.

BACKGROUND: Diabetes mellitus places a considerable burden on the individual and the family with respect to lifestyle changes. There is a paucity of systematic studies in India examining the efficacy of self-management programs for diabetes. The study examined the impact of a brief self-management intervention (SMI) on primary outcome of HbA1c and secondary outcomes of quality of life (QOL), self-care, perceived barriers to self-care (BSC), perceptions regarding illness and mood in patients with type 2 diabetes mellitus. METHODS AND MATERIALS: Eighty patients with type 2 diabetes mellitus were randomly allocated to either a 4-session SMI or treatment as usual (TAU) and were assessed on HbA1c levels, QOL, self-care, BSC, illness perceptions, anxiety, and depression at baseline, postintervention , and at three-month postintervention follow-up. RESULTS: Repeated measures analysis of variance indicated significant improvement in the SMI group from baseline to follow-up on HbA1c (P = 0.001), impact of diabetes on QOL (P = 0.006), self-care with respect to diet and exercise (Ps = 0.001), perceived barriers in adherence to diet, exercise, (P = 0.001), medication (P < 0.01), glucose testing (P = 0.04), general BSC (P = 0.001), total barriers (P = 0.001), illness perceptions-timeline or chronicity of illness (P = 0.002), personal control over illness, (P = 0.001), belief in effectiveness of treatment (P = 0.002), understanding of one's illness (P = 0.001), and emotional representations regarding illness (P =0.001), depression, (P = 0.001), and anxiety (P = 0.001). In the SMI group, large effect sizes were obtained at the postintervention assessment and the three-month follow-up on most outcome measures. CONCLUSIONS: Brief psychological intervention is efficacious in patients with type 2 diabetes.

Emotion Recognition, Emotion Awareness, Metacognition, and Social Functioning in Persons with Schizophrenia.

BACKGROUND: Emotion processing has received significant research attention in persons with schizophrenia. However, some aspects of this construct, such as emotion awareness, are less researched. In addition, there is limited work on metacognitive awareness and social functioning in persons with schizophrenia. METHODS: Our sample comprised of 27 participants with schizophrenia- and 26 nonclinical controls. The clinical group was assessed on Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Tool for Recognition of Emotions in Neuropsychiatric Disorders, Toronto Alexithymia Scale, Metacognitive Assessment Scale, self-reflectiveness subscale of Beck's Cognitive Insight Scale, Scale S and Scale U subscales of the Metacognitive Assessment Scale, and Groningen's Social Dysfunction Scale. RESULTS AND CONCLUSION: Participants with schizophrenia had greater deficits in emotion recognition than nonclinical controls (P = 0.05, df = 51). There was no significant correlation between emotion recognition and metacognition in the clinical group. The presence of negative symptoms was significantly associated with social functioning in persons with schizophrenia. KEY MESSAGES: Clinical symptoms, in particular negative symptoms, play an important role in social functioning in persons with schizophrenia and it is necessary to address these along with social cognition in order to improve functioning.

Risky Riding and Its Correlates in Two-Wheeler Riding Young Men: Pillion Riders' Perspective.

BACKGROUND: Risky riding is one of the major contributing factors in road fatalities. The present study aimed to explore the risky riding behaviors and its correlates in two-wheeler riding young men, as ascertained from pillion riders' perspective. MATERIALS AND METHODS: A survey that captured perspective of pillion riders about two-wheeler riding young men with whom they used to pillion ride most frequently was administered on 115 subjects. The survey consisted of items pertaining to risky riding, perceived impact of negative emotion on riding, expression of negative emotion on roads in response to frustrating situations, road traffic accidents, and pillions' strategies to reduce anger/stress in their two-wheeler riders. RESULTS: Two-wheeler riders who comprised young men were categorized into two groups: (i) high-risk riding group (n = 54 [48%]) and (ii) low-risk riding group (n = 61 [52%]) based on the subjective report of risky riding behaviors by their pillion riders. The results showed that negative emotions were perceived to have adverse influence on riding in persons with high-risky riding. Pillion riders reported that two-wheeler riding young men with high-risky riding expressed more aggressive behaviors (verbal and nonverbal) while riding in response to frustrating situations and also experienced near misses and minor accidents more frequently than their counterparts. Pillion riders reported utilizing various strategies to regulate emotions and behaviors of two-wheeler riders. CONCLUSIONS: The present study highlights assessing risky riding and their correlates from pillion riders' perspective and strengthening their positive influence on two-wheeler riding. It has significant implications in minimizing risky behaviors on roads and enhancing road safety.

New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

Self-Reported Anger: Vulnerability for Risky Behaviors in Two-Wheeler Riding Young Men.

OBJECTIVES: Aggressive driving and road accidents are major concerns in the public health sector. This study aimed to explore risk to aggressive and risky behaviors on the road in two-wheeler riding young men. METHODS: The study comprised 433 young male two-wheeler riders from an urban city of India. A two-wheeler riding survey that captured subjective perception of difficulty in managing anger in general, easy provocability to anger, and aggressive and risky behaviors on the road, and Negative Mood Regulation (NMR) scale were administered. RESULTS: Of the 433 participants, 83 (19%) reported experiencing problematic anger in general, whereas 175 (40.42%) did not endorse experiencing problematic anger. Based on this, two groups were formed, namely, problematic anger-present group and problematic anger-absent group. The problematic anger-present group reported high score on easy provocability to anger, difficulty in controlling anger, specific motives related to riding fast than usual, and severity of aggressive responses to frustrating situations while riding, and low score on NMR scale. Statistical analysis revealed a significant difference between the groups. CONCLUSION: This study highlights the relevance of assessing subjective perception of problematic anger in two-wheeler riding young men. This has implications for designing interventions for enhancing road safety.

Cognitive behavioural interventions in addictive disorders.

Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders. CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories. The focus of CBT is manifold and the focus is on targeting maintaining factors of addictive behaviours and preventing relapse. Relapse prevention programmes are based on social cognitive and cognitive behavioural principles. Interventions for preventing relapse include, behavioural strategies to decrease the valence of addictive behaviours, coping skills to deal with craving, arousal, negative mood states, assertiveness skills to manage social pressures, family psychoeducation and environmental manipulation and cognitive strategies to enhance self-efficacy beliefs and modification of outcome expectancies related to addictive behaviours. More recent developments in the area of managing addictions include third wave behaviour therapies. Third wave behaviour therapies are focused on improving building awareness, and distress tolerance skills using mindfulness practices. These approaches have shown promise, and more recently the neurobiological underpinnings of mindfulness strategies have been studied. The article provides an overview of cognitive behavioural approaches to managing addictions.

Perceptions of Accredited Social Health Activists on Depression: A Qualitative Study from Karnataka, India.

BACKGROUND: Depression is a significant public health concern in India, associated with a large treatment gap. Assessing perceptions of Accredited Social Health Activists (ASHAs) on depression can be invaluable as they are selected to work at the interface between their own communities and the health-care delivery system. AIMS AND OBJECTIVES: This study aimed at utilizing a qualitative approach to examine the ASHAs' understanding of depression, their mental health-care practices specific to depression, and their capacity-building needs with regard to identification and helping persons with depression. SUBJECTS AND METHODS: A cross-sectional qualitative study using two focus group discussions was conducted. The sample comprised 14 ASHAs in the age range of 25-45 years from Bengaluru urban district. The data were analyzed manually by the method of directed content analysis. RESULTS: The ASHAs were found to have inadequate knowledge of the signs and symptoms of depression, its biopsychosocial nature, and its impact on functioning. Causation of depression was narrated in terms of psychosocial stressors. The majority expressed the need for primarily psychosocial interventions for depression. All participants reported their motivation to obtain training in identifying persons with depression and providing simple psychosocial intervention for them. CONCLUSION: This study indicates that ASHAs have poor knowledge of depression, which could be leading to its low recognition and treatment in the communities they work in. They are therefore likely to benefit from capacity building on depression which includes familiar nomenclature, biopsychosocial elucidation of the illness, life-span approach, understanding of its impact on various domains of functioning, and the treatments available.

Advances in psychological interventions for lifestyle disorders: overview of interventions in cardiovascular disorder and type 2 diabetes mellitus.

PURPOSE OF REVIEW: The present review examines the recent advances in psychological interventions for two major lifestyle disorders in adults namely, type 2 diabetes mellitus and cardiovascular disorders. The review summarizes findings from studies carried out between the years 2015 and 2017. RECENT FINDINGS: The effectiveness of psychological interventions in the management of lifestyle disorders has been examined with respect to adaptation, self-care, adherence, negative emotions and improving quality of life. There is an increasing recognition that psychological interventions are important for prevention of lifestyle disorders and promotion of health. Key psychological interventions include self-management and educational interventions based on learning and motivational principles, patient empowerment, cognitive behaviour therapy, behavioural skills and coaching. Recent developments also include the use of information technology to deliver these interventions through internet, mobile applications and text messages. Another significant development is that of mindfulness-based interventions within the third-generation behaviour therapy approaches to reduce distress and increase acceptance. In addition, family and couples interventions have also been emphasised as necessary in maintenance of healthy behaviours. SUMMARY: Studies examining psychological interventions in cardiovascular and type 2 diabetes mellitus support the efficacy of these interventions in bringing about changes in biochemical / physiological parameters and in psychological outcomes such as self-efficacy, knowledge, quality of life and a sense of empowerment.