Endoxifen in Treatment of Individuals with Borderline Personality Disorder with Predominant Impulsivity: A Case Series.

Endoxifen, a protein kinase C inhibitor, has been approved for use in manic episodes in India. One of the symptom traits that it predominantly targets is impulsivity. Impulsivity can also be a symptom dimension of other mental health conditions, one of which is Borderline Personality Disorder (BPD). Management of BPD is challenging, with limited pharmacological options that are symptom-directed and psychotherapy sessions that are fraught with early dropouts and lack of compliance. Impulsive behaviors represent a major reason for seeking help in BPD, especially with regard to non-suicidal self-injury, substance abuse, high-risk sexual behavior, aggression, etc. Here, we present a case series comprising five individuals with a diagnosis of BPD whose treatment regimens were changed and endoxifen added at a dose of 8 mg once daily. Clinical improvement was monitored using the Borderline Evaluation of Severity Over Time (BEST). All the subjects improved in the impulsivity domains as well as with regard to attention deficits, mood fluctuations, and overall functioning. Endoxifen is thus potential promising in terms of the management of BPD, but needs more extensive study to fully substantiate its clinical benefits.

"The Unheard Voices": Lived Experiences of Sexual Abuse in Male Survivors.

Background: Victims of sexual abuse face unique emotional challenges. Among them, the male survivors of sexual assault have largely been neglected in the literature, being traditionally considered "against the norm" and symbolic of reduced masculinity. Methods: Qualitative approach was used to study the lived experiences of five (three heterosexual and two homosexual) male survivors of sexual abuse. In-depth interviews were conducted with consent, transcribed verbatim, and analyzed using interpretative phenomenological analysis (IPA). Results: Commonality in the experiences of abuse (the identity of the abuser, nature of agony), perspectives of sharing the abuse history (lack of acceptance of "male" victimhood, the openness of the opposite gender, family reactions), and the long-term impact of abuse (withdrawal/change of interest as coping, sexual identity issues) emerged as the main superordinate theme (and subthemes). Conclusion: Society, with its patriarchy, often turns apathetic to male victimization in sexual abuse. Beliefs about masculinity and resultant trauma can cause a chronic social and psychosexual impact on the victims. More systematic research is needed to understand their perceptions, unmet needs, and experiences of recovery.

IPA and WPA-SOAP position statement on deprivation of liberty of older persons with mental health conditions.

In recognition of the challenges faced by older persons deprived of their liberty, a call was made for input into the 2022 report to the United Nations Human Rights Council (HRC) on older persons. This Position Statement outlines the views of two global organizations, the International Psychogeriatric Association (IPA) and the World Psychiatric Association Section of Old Age Psychiatry (WPA-SOAP), working together to provide rights and dignity-based mental health services to older persons and it was sent to the Independent Expert on the enjoyment of all human rights by older persons at HRC.

"It seemed like my fault for wanting to become a mother "-Experiences and perceptions related to motherhood in women with severe mental illness.

BACKGROUND: Women with mental illness experience unique challenges during their motherhood. However, little is known about their own perceptions and unmet needs in the process of childbearing. A qualitative study design with a social constructivist paradigm was used to explore lived experiences of mothers with severe mental illness (SMI) during the childbearing period. METHODS: Semi-structured in-depth interviews were conducted with 30 mothers recruited through purposive sampling. This was followed by inductive thematic analysis. Rigor was established through triangulation and respondent validation. This paper focuses on the perceptions during the pre-conception and pregnancy period. RESULTS: Emergent categories (themes) were thoughts/feelings about childbearing (ambivalence about being a mother/having a baby, fantasies about childbearing/rearing, guilt about pregnancy), the impact of mental illness (stigma, effect of symptoms on their self-care including healthcare, concerns about effect of medications on fetus), unmet needs (lack of emotional support, unanswered doubts about effects of illness on pregnancy, child and motherhood, wanting to be considered as "potential mothers"), and caregivers' reactions (discrimination, anger/abuse, selective support). The centrality of motherhood and balancing the "dual role" of a patient and mother were the overarching categories after analysis. CONCLUSION: Mothers with SMI prize motherhood but navigate through it with various adverse experiences. The results of this study, grounded in their voices, provide critical insights for service and policy provisions in perinatal psychiatry.

Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries.

Suicide is a global health issue that needs to be addressed. The COVID-19 pandemic has resulted in an increased mental health burden. Stigma has obstructed efforts to prevent suicide as individuals who need urgent support do not seek appropriate help. The influence of stigma is likely to grow in tandem with the COVID-19 pandemic. The stigmatization of persons with mental illnesses is widespread worldwide, and it has substantial effects on both the individual and society. Our viewpoints aim to address the probable link between stigma and suicide in the wake of the current pandemic and propose ideas for reducing suicide-related stigma.

Perceived Barriers in the Assessment and Management of Female Sexual Dysfunction: a Survey Among Resident Trainees in Psychiatry.

OBJECTIVE: The authors examined the perceived barriers in the assessment and management of female sexual dysfunction among resident trainees in psychiatry. METHODS: An online survey was conducted among 148 resident trainees in psychiatry at a tertiary academic psychiatry center in India. It consisted of nine items with responses rated on a Likert scale. The anonymity of the responses was maintained. RESULTS: A total of 73 residents (49.3%) responded to the survey. Spontaneous reporting of sexual functioning, which is patient-driven, and spontaneous inquiry, which is resident-driven, were lacking. Specific barriers identified in the majority were lack of time, privacy, linguistic challenges, limited knowledge, and sociocultural background of the patient. The gender of the resident was not perceived as a major barrier in a majority. Marital discord appeared as a common response for inquiries into sexual functioning, while the use of psychotropics, the presence of medical comorbidities, and the postmenopausal state did not attract a majority to inquire about the same. Furthermore, a response that there was a lack of intervention in those reporting sexual dysfunction was commonly noted. Only 5.5% of the participants reported having received adequate formal training in the management of female sexual dysfunction. CONCLUSION: Female sexual dysfunction is common, adds to psychiatric morbidity, and affects the quality of life. It is important to impart training on female sexual dysfunction as a part of their residency program with cultural appropriateness. A future direction would be to evaluate the effectiveness of a formal training program for assessing and managing female sexual dysfunction.

The national suicide prevention strategy in India: context and considerations for urgent action.

India reports the highest number of suicide deaths in the world. At this time when the Indian Government is formulating a national suicide prevention strategy, we have reviewed the current status of suicides in India, focusing on epidemiology, risk factors, and existing suicide prevention strategies to identify key challenges and priorities for suicide prevention. The suicide rate among Indian girls and women continues to be twice the global rate. Suicide accounts for most deaths in the 15-39 years age group compared with other causes of death. Hanging is the most common method of suicide, followed by pesticides poisoning, medicine overdose, and self-immolation. In addition to depression and alcohol use disorders as risk factors, several social and cultural factors appear to increase risk of suicide. The absence of a national suicide prevention strategy, inappropriate media reporting, legal conflicts in the interpretation of suicide being punishable, and inadequate multisectoral engagement are major barriers to effective suicide prevention. A scaffolding approach is useful to reduce suicide rates, as interventions provided at the right time, intensity, and duration can help navigate situations in which a person might be susceptible to and at risk of suicide. In addition to outlining research and data priorities, we provide recommendations that emphasise multilevel action priorities for suicide prevention across various sectors. We call for urgent action in India by integrating suicide prevention measures at every level of public health, with special focus on the finalisation and implementation of the national suicide prevention strategy.

Dignity of Older Persons With Mental Health Conditions: Why Should Clinicians Care?

With a steady increase in population aging, the proportion of older people living with mental illness is on rise. This has a significant impact on their autonomy, rights, quality of life and functionality. The biomedical approach to mental healthcare has undergone a paradigm shift over the recent years to become more inclusive and rights-based. Dignity comprises of independence, social inclusion, justice, equality, respect and recognition of one's identity. It has both subjective and objective components and influences life-satisfaction, treatment response as well as compliance. The multi-dimensional framework of dignity forms the central anchor to person-centered mental healthcare for older adults. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. However, notwithstanding the growing body of research on the neurobiology of aging and old age mental health disorders, dignity-based mental healthcare is considered to be an abstract and hypothetical identity, often neglected in clinical practice. In this paper, we highlight the various components of dignity in older people, the impact of ageism and mental health interventions based on dignity, rights, respect, and equality (including dignity therapy). It hopes to serve as a framework for clinicians to incorporate dignity as a principle in mental health service delivery and research related to older people.

"Crisis Within the Walls": Rise of Intimate Partner Violence During the Pandemic, Indian Perspectives.

The ongoing coronavirus disease 2019 pandemic has been a social "un-equalizer," besides being a global health threat. Gender inequality has been globally prominent during the outbreak and the consequent lockdown. Although domestic abuse and intimate partner violence have increased due to chronic entrapment, overcrowding in families, enhanced substance use, distorted relationship dynamics, travel restrictions, and reduced healthcare access, coercive sexual practices have also been on the rise. In low- and middle-income countries, the lack of awareness, societal pressure, administrative apathy, fear of legal hassles, and inadequate knowledge-attitude-practice related to help-seeking lead to underreporting and mismanagement of domestic abuse, which can perpetuate its vicious cycle during the ongoing crisis. India, with its socio-culturally diverse population, has been one of the nations worst hit by the pandemic. With the rise in reports of gender-based violence on the premise of preexisting gender inequality and minority stress, concerns behind "closed doors" are as threatening as the infection itself. With this background, the authors highlight the backdrop of domestic violence as a "hidden pandemic" during the coronavirus disease 2019 crisis, drawing on perspectives from India and briefly reviewing the data from other nations. The role of mental health education and digital literacy as mitigating strategies is subsequently discussed.

A Psychosocial Exploration of Body Dissatisfaction: A Narrative Review With a Focus on India During COVID-19.

COVID-19 has been an unprecedented global crisis. Besides the public health impact, the pandemic necessitated measures, such as quarantine, travel restrictions, and lockdown, that have had a huge effect on digital screen time, dietary habits, lifestyle measures, and exposure to food-related advertising. At the same time, a reduction in physical activity, an increase of social media consumption, and an increase in fitness tutorials during the lockdown have contributed to body image issues. Emerging evidence from India suggests that peer conversations about appearance as negative body talk (fat talk) is particularly salient in contributing to body dissatisfaction and body perception ideals, which are more prevalent in women. Even though there has been an increase in research on the psychosocial impact of COVID-19, its influence on body image perceptions and consequent distress have been stigmatized and classified as under-spoken areas. With this background, this article reviews research on the biopsychosocial factors that influence body dissatisfaction among women, particularly the role of media. It also highlights the development of body image concerns in India, one of the worst-hit countries in the pandemic, through liberalization, importing Western notions of body instrumentality, demographic shift, and resultant social changes. Finally, the psychosocial strategies for positive body image ideas to prevent and mitigate the adverse effects of body dissatisfaction are discussed, particularly those that focus on cognitive behavioral techniques (CBTs) from the perspectives of positive psychology, media literacy programs, and involvement of the media. Interventions and further research to address body dissatisfaction among women, especially in the post-COVID aftermath, need to be a recognized as a public health goal.