Work productivity (absenteeism and presenteeism) in persons with common mental disorders: An observational study from South India.

Background: The greatest contributor to the economic impact of common mental disorders (CMDs) is said to be the loss of work productivity. There is a paucity of studies from India that looks at the impact of CMDs on the productivity of work, which costs both patient and society significantly. Aim: To assess and compare work productivity by evaluating both absolute and relative presenteeism and absenteeism, in persons with CMDs. Materials and Methods: This was a cross-sectional observational study on 220 subjects (110, 58, and 52 patients with depressive disorder, anxiety disorders, and somatoform disorders, respectively), recruited through purposive sampling. We evaluated work productivity using the World Health Organization Health and Work Performance Questionnaire. Results: Absolute absenteeism was significantly different before and after treatment for CMDs as a group but not for individual disorders. Relative absenteeism, absolute presenteeism, and relative presenteeism were all significantly different before and after treatment among both CMDs as a group and also among individual disorders. Both presenteeism and absenteeism (absolute as well as relative) did not differ significantly across the diagnostic groups. Work productivity has been linearly associated with illness severity and disability. Conclusion: CMDs are associated with a significant loss of work productivity. Presenteeism is costlier than absenteeism in affecting work productivity. Loss of work productivity appears to be transdiagnostic across all CMDs. Also, the severity of loss of work productivity is associated linearly with the severity of illness and disability.

Family intervention for expressed emotion in schizophrenia: Indian context.

Background: Expressed emotion (EE) being a part of the family environment could adversely affect the course and prognosis of schizophrenia. Aim: This study aimed to assess the effects of family intervention among the caregivers of persons with schizophrenia. Methods and Materials: The experimental research design was used for 80 caregivers of persons with schizophrenia. Sociodemographic interview schedule of caregivers, family emotional involvement and criticism scale, and mini international neuropsychiatric interview (MINI 6.0) were used for data collection. A standardized family intervention program involving 10 sessions was provided to caregivers. The intervention included six sessions of family psychoeducation, two sessions of communication training, one session of stress management, and one session on recap and referral services over a period of 2-3 months. The intervention used methods of social case and group work, social work principles, and therapeutic activities. The methodologies adopted a brainstorming technique, case vignettes, role plays, and video clippings concerning the topics of the day. Brief handout on intervention was given. Results: The RMANOVA score (F = 35.892; P =0.001) revealed that there was a significant reduction in EE of the caregivers of the intervention group who underwent the family intervention program in comparison with the control group. Conclusion: Family-based intervention was found to be effective for reducing EE in schizophrenia.

Stake holder perspectives on the role of accredited social health activists (ASHAs) in Indian public mental healthcare space: A qualitative study.

Background: Community health workers such as Accredited Social Health Activists (ASHAs) are existing resources who can facilitate the bridging of the mental health treatment gap. Knowing about the perspectives of ASHAs in delivering mental health care and other professionals with experience working in the area of community mental health is imperative. Method: As part of an implementation research project aimed at comparing the effectiveness of two training methods for community health workers (ASHAs), we conducted five focussed group discussions including four with ASHAs (n = 34) and one with other stakeholders (n = 10). Focussed Group Discussion (FGD) was conducted under the following themes: acceptance and feasibility of provision of mental health services from ASHA's point of view and understanding the supply and demand side opportunities and challenges. The discussion began with open-ended questions, allowing for new themes to emerge until saturation was reached. Results: ASHAs were willing to incorporate mental health identification (and referral) in their regular activities without additional perceived burden. ASHAs were easily able to identify severe mental disorders (SMDs). For substance use disorders (SUDs), due to factors such as normalization of substance consumption and stigma, there was a felt difficulty in the recognition by ASHAs. ASHAs' difficulty in identifying the CMDs was because of poor awareness in both those with mental illness and ASHAs. Incentivizing the work of ASHAs was thought to yield more returns. Conclusions: ASHAs have the potential to be excellent resources for easy screening, identification, and follow-up of those with mental health concerns in the community. Policies to involve them need to evolve.

Economic Perspectives on Setting up and Running Telepsychiatry Services in India.

BACKGROUND: Telemedicine Practice Guidelines, 2020 and Telepsychiatry Operational Guidelines, 2020 can be potential game changers in the practice of medicine in India. They provide legal grounds for the practice of telemedicine. The economics of setting up and running telepsychiatry services vis-à-vis in-person services in India is discussed in this paper to aid the practitioners in understanding the costs involved in each of these modalities. METHODS: Costs for various hardware, software, real estate, and human resources are collated from various sources. Telepsychiatry vs. in-person setup is compared for the costs involved. RESULTS: Telepsychiatry consultation will cost much lesser to that of in-person consultation. CONCLUSIONS: Telepsychiatry is an economically viable option. There are many benefits and hurdles in telepsychiatry practice. It is a step towards providing psychiatric services at the doorstep in compliance with the Mental Healthcare Act 2017, upholding the rights of persons with mental illness. It will benefit the practitioner, the patient, and the society.

Sociodemographic, Legal, and Clinical Profiles of Female Forensic Inpatients in Karnataka: A Retrospective Study.

BACKGROUND: Forensic patients are often admitted to psychiatric hospitals without any details of illness or treatment. They pose a unique challenge for clinical services in the context of diagnosis, management, and particularly legal issues. MATERIALS AND METHODS: We conducted a retrospective chart review using a structured data-extraction tool. A total of 23 female forensic inpatients were admitted under the Department of Psychiatry from January 2006 to June 2016. Data were analyzed by descriptive statistics. RESULTS: The mean age of the patients was 31.3 ± 7.9 years. In total, 82.6% of them were married, 87% were from a nuclear family, and 78.3% were from an urban background. Totally, 73.9% were referred from prison and 26.1% from the court. However, 73.9% were referred for the purpose of diagnosis and treatment and 21.7% for assessment of fitness to stand trial. Moreover, 47.8% had an alleged charge of murder (of killing close family members). A total of 30.4% had schizophrenia and other psychotic disorders, and 47.8% had a mood disorder. The mean duration of inpatient care was 6.2 ± 7.4 weeks, and 87% had shown considerable clinical improvement at the time of discharge. CONCLUSIONS: The majority of female forensic patients were young adults from nuclear families. They had mood disorders, schizophrenia, and other psychotic disorders. They were referred primarily for treatment purposes. Prospective studies are required for a better characterization of the relationship between crime and psychiatric disorders.

Indian guidelines on neurosurgical interventions in psychiatric disorders.

Neurosurgery for psychiatric disorders (NPD) has been practiced for >80 years. However, the interests have waxed and waned, from 1000s of surgeries in 1940-1950s to handful of surgery in 60-80s. This changed with the application of deep brain stimulation surgery, a surgery, considered to be "reversible" there has been a resurgence in interest. The Indian society for stereotactic and functional neurosurgery (ISSFN) and the world society for stereotactic and functional neurosurgery took the note of the past experiences and decided to form the guidelines for NPD. In 2011, an international task force was formed to develop the guidelines, which got published in 2013. In 2018, eminent psychiatrists from India, functional neurosurgeon representing The Neuromodulation Society and ISSFN came-together to deliberate on the current status, need, and legal aspects of NPD. In May 2018, Mental Health Act also came in to force in India, which had laid down the requirements to be fulfilled for NPD. In light of this after taking inputs from all stakeholders and review of the literature, the group has proposed the guidelines for NPD that can help to steer these surgery and its progress in India.

Gender differences in the psychological impact of tsunami.

AIM: The aim of this observational study was to explore gender-related differences in psychiatric morbidity during the initial three months following the December 2004 earthquake and tsunami involving the Andaman and Nicobar Islands, India. METHODS: There were 12,784 survivors sheltered across 74 relief camps with 4,684 displaced survivors in Port Blair and 8,100 non-displaced survivors in Car-Nicobar Island. All persons who accessed mental health assistance within the camps constituted the study sample. Diagnoses were made by qualified psychiatrists using the ICD-10. There were 475 patients: 188 (40%) men and 287 (60%) women. RESULTS: There were significant gender differences in terms of displacement. There were significantly higher levels of panic disorder, unspecified anxiety disorder and somatic complaints in the displaced women while the non-displaced population showed more adjustment disorder. CONCLUSIONS: Displacement was a significant factor in the manifestations of observed pathology. Displaced women had greater psychiatric morbidity. In addition, the fact that adjustment disorder (a self-limiting disorder form of psychopathology) was more prevalent in the non-displaced group may be a reflection of the findings of overall lesser morbidity in non-displaced women. Hence, women may have to be rehabilitated in their own habitats after major disasters.

Clinically significant hoarding in obsessive-compulsive disorder: results from an Indian study.

BACKGROUND: Hoarding is frequently conceptualized as a symptom of obsessive-compulsive disorder (OCD), but recent evidence indicates that, in most cases, hoarding may be better conceptualized as a distinct disorder that can coexist with OCD. Most of the research on hoarding is from the Western countries. This study aimed to provide data on the prevalence and correlates of clinically significant hoarding in a large sample of patients with OCD from the Indian subcontinent. METHODS: We examined 200 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically significant hoarding using the Saving Inventory-Revised, followed by a clinical interview. RESULTS: Twenty patients (10%) had clinically significant hoarding. In all cases, hoarding did not appear to be related or secondary to other OCD symptoms. None of the cases consulted for their hoarding problems. Compared with nonhoarders, hoarders hailed exclusively from an urban background and had a significantly higher frequency of certain obsessions and compulsions, bipolar disorder, generalized anxiety disorder, cluster C personality disorders, and a higher number of lifetime suicidal attempts. They also had a more severe OCD along with poorer global functioning and somewhat poorer insight into obsessive-compulsive symptoms. CONCLUSIONS: The results suggest that clinically significant hoarding is relatively prevalent in Indian patients with OCD and that it appears to be largely unrelated to the OCD phenotype. However, the presence of comorbid hoarding is associated with more severe OCD, high comorbidity, more suicidal attempts, and a lower level of functioning. The results contribute to the current nosologic debate around hoarding disorder and provide a unique transcultural perspective.

Does insight have specific correlation with symptom dimensions in OCD?

OBJECTIVE: To study relationship between insight and clinical characteristics in subjects with obsessive-compulsive disorder (OCD). METHOD: Sample included 545 consecutive patients with a primary diagnosis of DSM-IV OCD who consulted a specialty OCD Clinic at a tertiary psychiatric hospital in India between January 2004 and December 2009. They had been evaluated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom checklist, severity rating scale and the item 11 for insight, the Mini International Neuropsychiatric Interview (MINI) and the Clinical Global Impression scale (CGI). Regression analyses were performed to identify predictors of insight. RESULTS: The sample had 498 (91%) subjects with good insight (score≤2) and 47 (9%) subjects with poor insight (score>2) as per the Y-BOCS item11. Poor insight group had a significantly higher score on the Y-BOCS compulsions (p<0.001) and total score (p=0.001), the CGI-Severity (p=0.001) and a higher rate of contamination fears (p<0.001) and washing compulsions (p<0.001). Good insight group had a significantly higher frequency of aggressive obsessions (p<0.001). In linear regression, contamination dimension (p=0.007) and Y-BOCS total score (p<0.001) predicted poorer insight and presence of forbidden thoughts (p=0.006) predicted better insight. LIMITATIONS: Study sample is from a specialty OCD clinic of a major psychiatric hospital in India and therefore, generalizability to other clinical settings may be limited. CONCLUSION: Poor insight is associated with severe form of OCD, and is associated with contamination dimension. That degree of insight has specific correlation with certain symptom dimensions adds to the growing knowledge on the dimensional aspect of OCD. Insight has to be systematically assessed in all OCD subjects particularly in those with contamination fears. Failure to systematically assess insight may have treatment implications.