Cultural Expression of Anxiety Symptoms in Kannada Language: A Qualitative Study.

Background: In anxiety disorders, culture is important in symptom presentation and help-seeking. Most tools for anxiety disorders are not validated in India and thus might not capture culture-specific aspects of anxiety. This study aims to identify and generate culturally specific terms to describe symptoms of anxiety as part of the development of the Kannada version of the Panic and Anxiety National Indian Questionnaire (PANIQ). The PANIQ is a tool under development to identify anxiety and panic in Indian settings. Methods: This study used qualitative methods like focus group discussions (FGDs) and in-depth interviews (IDIs) to identify and generate items related to anxiety and panic in Kannada from stakeholders like individuals with anxiety disorders, their caregivers, healthcare workers, and mental health professionals who treat individuals with anxiety and panic disorders. Five FGDs (n = 28), one triad (n = 3), and 34 IDIs (n = 34) were conducted. Results: The mean age of the participants was 38.9 (standard deviation: 12.28) years; 57.1% were from rural areas. We generated 615 Kannada items. These were classified into 21 domains and facets. Items in domains like Somatic symptoms, Fear, and Impairment in day-to-day life were higher than those noted in existing tools for anxiety that focus more on cognitive symptoms of anxiety. Conclusions: This study generated culturally specific items of anxiety through a qualitative process of tool development incorporating subjective experiences of persons with anxiety disorders and other stakeholders. This is among the first steps toward the development of PANIQ.

Facilitators and Barriers to Student Learning and Impact of an Undergraduate Clinical Posting in Psychiatry: A Thematic Analysis.

Background: There is an absence of information on empirical evaluation of undergraduate psychiatry training programs in India. We aimed to evaluate a clinical posting in psychiatry for undergraduate medical students. Methods: We employed levels one and two of Kirkpatrick's four-level program evaluation model. The qualitative study used written feedback that was collected using a semistructured questionnaire. For quantitative metrics, we used end-of-posting assessment scores and frequencies of standard comments provided by examiners on case-based discussions with students to evaluate their clinical skills. Results: We obtained written feedback from 40 female and 19 male fifth-semester students. We identified facilitators (patient interaction, outpatient department observation and teaching, demonstration of signs, case presentation and discussion, evening posting, observation of clinical work, use of anecdotes while teaching, and lectures by senior faculty) and barriers (organizational issues related to evening posting and disinterest in didactic teaching) to the students learning psychiatry, and the perceived impact of the posting for the students (changed attitudes, knowledge, self-efficacy, and skills acquired). The mean total score on case-based discussion, assigned to 22 groups of students, was 3.86 out of 5. Conclusion: We described the impact of the posting and identified unique facilitators and barriers to students' learning in psychiatry. These findings will inform the choice of teaching-learning methods in the context of the new Competency-Based undergraduate Medical Education (CBME) curriculum.

Effective and innovative teaching methods in psychiatry for the medical undergraduates in South India: An exploratory study of teachers' and students' perspectives.

Background: Effective teaching methods are important in psychiatry. Previous studies have focused on the assessment of students about the effective teaching methods but not on a self-assessment by teachers. Aims: Primary objective is to evaluate the teachers' and students' perspectives of effective teaching methods in psychiatry for medical undergraduates. Secondary objectives include assessment of the concordance of each item and exploring innovative teaching methods. Settings and Design: A cross-sectional study design used in teachers and medical students from St. John's Medical College, Bangalore (India). Methods and Material: A modified teachers and medical students perspectives of effective psychiatry teaching methods were used. Statistical Analysis: Differences in continuous variable assessed with independent sample-test and categorical variables with Chi-square test. The Domain scores were divided into tertiles and the highest and lowest tertiles were analyzed. Results: Both students and teachers had high perspectives on most of the teaching methods. Differences were found in items such as "using multimedia slide effectively," "good sense of humor while teaching," "presentation summarizes the key points," and "presentation links ideas effectively." Role play-based and live/simulated patient-based teachings were reported most frequently by both. Significantly, a higher proportion of the 6th term students and a lesser proportion of teachers were associated with the lowest tertiles for Domain 1, 2, and 3. Significantly, increased number of 8th term students were found in the higher tertiles in Domain 3. Conclusions: These findings have practical implications in identifying the gaps in effective teaching methods by the teachers. Teachers can improve their teaching methods by upgrading their presentation skills, employing new and innovative teaching skills.

A Randomized Controlled Trial to Assess Feasibility and Acceptability of Telephone-Based Psychosocial Interventions in Individuals who Attempted Suicide.

BACKGROUND: Brief contact interventions such as telephone-based contacts appear to be useful in individuals who attempted suicide. Most studies of telephone-based contacts in such individuals typically consisted of frequent phone reminders for adherence to treatment and seeking help for mental health issues. Telephone-based psychosocial interventions that incorporate elements of supportive and problem-solving strategies are of interest in Indian settings due to their potential application in mitigating the wide mental health gap. Feasibility studies of telephone-based psychosocial interventions could help ascertain the difficulties that arise in the implementation of such treatments. METHODS: A multicentric randomized controlled trial (RCT) is currently underway in general hospital settings in two Indian cities to study the efficacy of telephone-based psychosocial interventions in individuals with a recent suicide attempt, with routine telephone contacts (TCs) serving as the comparator. Prior to that RCT, this feasibility study was conducted to assess the acceptability of the telephone-based intervention and telephone contacts. Feasibility was assessed using dropout rates. Acceptability was assessed using participant-rated Likert-based visual analog scores from 0 to 10, with higher scores indicating greater acceptability. RESULTS: Dropout rates and mean acceptability scores for telephone-based psychosocial interventions were 38.5% and 8.63, while those for TCs were 41.7% and 7.57, respectively. CONCLUSIONS: Telephone-based psychosocial interventions are feasible and acceptable in individuals with a recent suicide attempt.

Do individuals follow up with mental health services after a suicide attempt? Findings from the assertive management of attempted suicide service, Bengaluru, India.

OBJECTIVE: There is limited information from India on whether individuals follow up with mental health services after a suicide attempt. The objective of this study was to determine follow-up rates after a suicide attempt with mental health services of those individuals treated as part of the assertive management of attempted suicide service in a general hospital in Bengaluru, India. MATERIALS AND METHODS: Records from 284 persons from January 2016 to December 2016 were analyzed to ascertain their follow-up rates with mental health services after a suicide attempt. RESULTS: After discharge, 25% individuals followed up on a single occasion with mental health services. Individuals with a psychiatric diagnosis were significantly more likely to follow up with mental health services as compared to those without a psychiatric diagnosis (P < 0.011, odds ratio: 2.875, confidence interval at 95%: 1.276-6.481). 90.8% were contacted through telephone as part of aftercare. CONCLUSIONS: Most individuals in India, especially those without a psychiatric diagnosis, do not follow up with mental health services after a suicide attempt. Periodic telephonic contacts are a useful aftercare strategy to reach out to this high-risk population. Limitation of this study is that findings are from an urban general hospital setting.

Protocol of a Multi-centric Randomized Controlled Trial to Evaluate Efficacy of Telephone-Based Psychosocial Interventions on Future Suicide Risk in Suicide Attempters.

BACKGROUND: Persons with previous history of a suicide attempt are at increased future risk of death by suicide. These vulnerable individuals, however, do not seek receive or seek help from mental health services. Telephone-based psychosocial interventions are potential strategies in augmenting mental health care in such persons. METHODS: We aim to compare the efficacy of telephone-based psychosocial interventions (TBPI) with routine telephone reminders in persons with recent suicide attempts using a multi-site, parallel group, rater-blind, two-arm randomized controlled trial design in 362 participants. In the first group, participants will receive three sessions of TBPI comprising of brief supportive interventions, problem-solving strategies, and reminders for adherence to prescribed mental health treatment at weekly intervals. In the second group, participants will receive three telephone reminders for adherence to prescribed mental health treatment at weekly intervals. We will follow up participants for 6 months. Primary outcomes are suicidal ideation scores on Beck's Scale for Suicide Ideation and number of repeat suicide attempts. Secondary outcomes are scores on Beck's Hopelessness Scale, Beck's Depression Inventory, Connor-Davidson Resilience Scale and Visual Analogue Rating Scales for acceptability of interventions. Outcomes will be assessed at 1, 3, and 6 months after receiving telephone interventions or reminders. RESULTS: The trial is currently underway after prospective registration under Clinical Trials Registry of India and has recruited 260 participants till August 15, 2020. CONCLUSION: This study has potential to generate evidence on additional strategies for use along with standard mental health treatments in management of high-risk suicide behaviors.

Challenges in Taking Sexual History: A Qualitative Study of Indian Postgraduate Psychiatry Trainees.

CONTEXT: In India, psychiatrist is an important point of helpseeking for sexual complaints. A detailed sexual history can go a long way in understanding sexual difficulties. In this background, there is inadequate information on the difficulties that psychiatry postgraduate trainees experience while taking a sexual history as part of a routine mental health evaluation. AIMS: The aim was to study the difficulties experienced by postgraduate psychiatry trainees while taking sexual history as a part of routine mental health evaluation. SETTING: This study was conducted in an Indian medical college general hospital psychiatry setting. MATERIALS AND METHODS: This is a qualitative study using focus group discussions and in-depth interviews with postgraduate psychiatry trainees. STATISTICAL ANALYSIS: Content analysis was used to identify direct and latent themes. RESULTS: Thematic saturation was achieved with 17 participants. Major themes of difficulties that emerged included trainee-related factors such as gender and sociocultural background of the trainee; patient-related factors such as age, gender, and sexual orientation; setting-related factors; and language-related difficulties. CONCLUSIONS: Specific and regular training in taking a sexual history is essential in addressing the difficulties faced by postgraduate psychiatry trainees in India.

Resilience in Wives of persons with Alcoholism: An Indian exploration.

CONTEXT: Mental health has currently shifted focus from "deficit" to strength-based approaches such as Resilience. Coping styles and personality factors have been well studied in Wives of persons with Alcoholism (WopA) but not Resilience. Alcohol dependence in spouse is seen as an adversity. AIMS: To evaluate Resilience in the WopA and explore its relationship with marital quality and clinical variables of Alcohol Dependence in their husbands. SETTINGS AND DESIGN: A cross-sectional study in a tertiary care hospital in Bangalore, Karnataka. SUBJECTS AND METHODS: WopA (n=34) between 25-55 years, were assessed for Resilience using Resilience Scale for Adults (RSA), while marital quality was assessed using Marital Quality Scale (MQS). The Severity of Alcohol Dependence, Age of onset of Initiation, Age of onset of Problem Drinking, and Age of onset of Dependence were evaluated in their husbands. STATISTICAL ANALYSIS: Independent sample t-test, Chi-square test, and Pearson's correlation were used. RESULTS: Majority of the WopA (82%) scored low on the RSA. Low Resilience (LR) WopA scored significantly lower on all factors of RSA except the perception of future; in comparison to High Resilience (HR) WopA. Additionally, the LR WopA reported significantly poorer marital quality. CONCLUSIONS: Most WopA had low Resilience. LR WopA also had significantly poor marital quality. These findings need to be studied further in a larger population with culturally appropriate scales. The low scoring Resilience factors amongst WopA may be utilized in strength-based psychotherapeutic approaches. There is a need to improve the understanding of Resilience and its assessment in this population.

A study to compare the differences between genders in psychiatric comorbidities in individuals with psychoses.

BACKGROUND: Psychiatric comorbidities worsen the outcome and increase severity of suffering in psychotic disorders. Gender differences have also been found to impact the severity and outcome in psychoses. In this background, this study attempted to compare psychiatric comorbidity between genders. AIMS AND OBJECTIVES: The aim was to compare psychiatric co-morbidity between men and women with psychotic disorders. METHODOLOGY: A descriptive cross sectional study design was used. Data was collected through clinical interviews using standardized tools as well as the current case records. We used the MINI neuropsychiatric interview 5.0 to generate an ICD 10 diagnosis for primary psychotic illness and psychiatric comorbidity. PANSS was used to assess severity. Calgary Depression Scale for Schizophrenia, Hamilton Anxiety rating scale, Yale Brown Obsessive Compulsive Scale, Alcohol Use Disorders Identification Test and Fagerstrom Nicotine Tolerance Questionnaire were used to study comorbidity. RESULTS: 100 patients were included in the study. 61% of the population had a psychiatric comorbidity. 42% of the men had significantly more multiple psychiatric comorbidities as compared to 7% among women. Men had significantly more substance use than women. Age of onset of psychosis was not found to be different between men and women. CONCLUSION: In this study men had more psychiatric comorbidity than women, owing to greater levels of substance use disorders and anxiety disorders. This could be one of the possible reasons for differing outcomes between men and women with psychotic disorders thus indicating need for systematic future researching in psychiatric comorbidities in psychoses.

Asperger syndrome in India: findings from a case-series with respect to clinical profile and comorbidity.

Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders.

Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city.

BACKGROUND: Tobacco-attributable mortality in India is estimated to be at least 10%. Tobacco cessation is more likely to avert millions of deaths before 2050 than prevention of tobacco use initiation. OBJECTIVE: To describe the clinico-epidemiological profile of attendees of a tobacco cessation clinic in a teaching hospital in Bangalore city. MATERIALS AND METHODS: A descriptive study of 189 attendees seen over 2 years in the Tobacco Cessation Clinic of a tertiary-care teaching hospital in Bangalore, with information on socio demographic characteristics, tobacco-use details, nicotine dependence, family/medical history, past quit attempts, baseline stage-of-change, and treatment initiated. RESULTS: Only 5% were 'walk-in' patients; 98% of attendees were smokers; 97% were males. The mean (±SD) age of attendees was 48.0 (±14.0) years. Most participants were married (88%), and predominantly urban (69%). About 62% had completed at least 8 years of schooling. Two-thirds of smokers reported high levels of nicotine dependence (Fagerström score >5/10). About 43% of patients had attempted quitting earlier. Four-fifths (79%) of tobacco-users reported a family member using tobacco. Commonly documented comorbidities included: Chronic respiratory disease (44%), hypertension (23%), diabetes (12%), tuberculosis (9%), myocardial infarction (2%), stroke (1%), sexual dysfunction (1%) and cancer (0.5%). About 52% reported concomitant alcohol use. At baseline, patients' motivational stage was: Precontemplation (14%), contemplation (48%), preparation/action (37%) and maintenance (1%). Treatment modalities started were: Counseling alone (41%), nicotine replacement therapy alone (NRT) (34%), medication alone (13%), and NRT+medication (12%). CONCLUSIONS: This is the first study of the baseline profile of patients attending a tobacco cessation clinic located within a chest medicine department in India. Important determinants of outcome have been captured for follow-up and prospective documentation of outcomes.

Assessing heart rate variability using a 12 lead ECG in patients with alcohol dependence syndrome.

Heavy or hazardous drinking is associated with an increased risk of cardiac morbidity and mortality and this has been attributed to abnormalities in cardiac autonomic regulation. Current study aimed to assess the role of simple indices derived from 12 lead ECG in subjects with chronic alcohol dependence. Data suggested that alcohol group had significantly lower 12 lead ECG derived RR variability compared to age and gender matched controls. Study further supports the implication of 12 lead derived RR variability indices in various clinical settings.