A community developed conceptual model for reducing long-term health problems in children with intellectual disability in India.

Children with intellectual disability (ID) have a higher risk of long-term health problems in adulthood. India has the highest prevalence of ID of any country with 1.6 million under-five children living with the condition. Despite this, compared with other children, this neglected population is excluded from mainstream disease prevention and health promotion programmes. Our objective was to develop an evidence-based conceptual framework for a needs-based inclusive intervention to reduce the risk of communicable and non-communicable diseases among children with ID in India. From April through to July 2020 we undertook community engagement and involvement activities in ten States in India using a community-based participatory approach, guided by the bio-psycho-social model. We adapted the five steps recommended for the design and evaluation of a public participation process for the health sector. Seventy stakeholders from ten States contributed to the project: 44 parents and 26 professionals who work with people with ID. We mapped the outputs from two rounds of stakeholder consultations with evidence from systematic reviews to develop a conceptual framework that underpins an approach to develop a cross-sectoral family-centred needs-based inclusive intervention to improve health outcomes for children with ID. A working Theory of Change model delineates a pathway that reflected the priorities of the target population. We discussed the models during a third round of consultations to identify limitations, relevance of the concepts, structural and social barriers that could influence acceptability and adherence, success criteria, and integration with existing health system and service delivery. There are currently no health promotion programmes focusing on children with ID in India despite the population being at a higher risk of developing comorbid health problems. Therefore, an urgent next step is to test the conceptual model to determine acceptance and effectiveness within the context of socio-economic challenges faced by the children and their families in the country.

The psychological impact of the COVID-19 pandemic and associated risk factors during the initial stage among the general population in India.

BACKGROUND: In the absence of treatment and unclear prognosis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself, and public health measures like lockdown enforced by the government to limit the spread of the virus poses a threat to the psychological health of the general population. AIM: To assess the psychological status of the Indian population during the initial phase of lockdown. METHOD: It was a cross-sectional online survey where the questionnaire was disbursed by snowballing. The link to the survey was shared in different social networking platforms between 6th and 22nd of April 2020. The questionnaire collected responses related to the sociodemographic variables, exposure history, precautionary measures used, and the Depression, Anxiety, and Stress Scale (DASS-21) score. RESULTS: A total of 541 participants responded to the questionnaire. Only 422 respondents' responses from 23 states of India who completed the questionnaire were included for assessment. The mean age of the participants was 30.5 (SD=10.9) years. Female constituted 60.4% (n=255) of the respondents. The pre-existing medical illness that the respondents had were diabetes mellitus, four per cent (n=17), hypertension, five per cent (n=21), thyroid dysfunction, nine per cent (n=38), and mental illness, five per cent (n=21). The median (IQR) of the DASS-21 item scale was found to be 16 (4-32). The percentage of the respondents who reported stress was 35.5% (n=149), anxiety, 32% (n=135), and depression, 34.7% (n=146). Respondents with sociodemographic variables like being single, student status, competed education till graduation, homemakers, working in public sector, and history of mental illness were more likely to experience stress, anxiety, and depression. A majority of the respondents were practicing hand hygiene and social distancing. Respondents who were unaware of their exposure status were more likely to have depression. CONCLUSION: The Indian population is experiencing the psychological impact of the coronavirus disease 2019 (COVID-19), which may increase with the spread of the infection. India needs to gear up to face mental health consequences. People with a pre-existing physical and psychological illness needs extra care and precaution to prevent any relapse or development of complications.

A novel approach to address the novel threat.

The editorial highlights the mental health initiative of the Government of Assam, India through the Monon: Assam Cares programme to deal with the coronavirus disease 2019 (COVID-19) pandemic. Through this initiative, trained mental health professionals proactively reached to people with COVID-19 to provide psychological aid.

Profile of distress callers and service utilisation of tele-counselling among the population of Assam, India: an exploratory study during COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected people globally by causing psychological, social, and economic chaos. The Assam Police, India started telephone helplines to address the psychological issues. AIMS: To evaluate the sociodemographic profile of the distress callers, their psychosocial concerns, the interventions provided by the service provider, and whether the service users were satisfied with the intervention(s) or not. METHOD: It was a cross-sectional study done during the period of lockdown (7-24 April 2020). All the callers who called the helpline were screened for anxiety, depression, suicidal thoughts (when required), and the psychosocial issues which they were facing were explored. They were provided the psychological intervention(s) at the appropriate time, and they were asked to rate their experience at the end. RESULTS: A total of 239 callers used the tele-counselling services. The majority of callers were male (79.1%). Most of the callers were between 19-35 years of age group (66.5%), married (52.5%), and graduates (31%). Two-thirds of the callers called to seek guidance for their own issues and one-third for their relatives or friends. Callers had anxiety (46%), depressive disorder (8.3%), and depressive symptoms not qualifying for depressive disorder (14%), and suicidal thoughts (5.44%). The commonest intervention provided to the callers was supportive (77.8%), followed by psychoeducation (30.5%), cognitive behaviour therapy (24.7%), relaxation (23.6%) and behaviour therapy (13.4%). Most of the callers utilised more than one type of therapy. Overall, most of the callers were satisfied and appreciated the tele-counselling services. CONCLUSION: The findings could help in formulating psychological interventions to improve the mental health of vulnerable groups in the post-COVID-19 period to reduce psychiatric morbidity and mortality.

Safety and efficacy of lopinavir/ritonavir combination in COVID-19: A systematic review, meta-analysis, and meta-regression analysis.

BACKGROUND: Being protease inhibitors and owing to their efficacy in SARS-CoV, lopinavir + ritonavir (L/R) combination is being used in the management of COVID-19. In this systematic review and meta-analysis, we have evaluated the comparative safety and efficacy of L/R combination. MATERIALS AND METHODS: Comparative, observational studies and controlled clinical trials comparing L/R combination to standard of care (SOC)/control or any other antiviral agent/combinations were included. A total of 10 databases were searched to identify 13 studies that fulfilled the predefined inclusion/exclusion criteria. RESULTS: No discernible beneficial effect was seen in the L/R group in comparison to SOC/control in terms of "progression to more severe state" (4 studies, odds ratio [OR]: 1.446 [0.722-2.895]), "mortality" (3 studies, OR: 1.208 [0.563-2.592]), and "virological cure on days 7-10" (3 studies, OR: 0.777 [0.371-1.630]), while the L/R combination arm performed better than the SOC/control arm in terms of "duration of hospital stay" (3 studies, mean difference (MD): -1.466 [-2.403 to - 0.529]) and "time to virological cure" (3 studies, MD: -3.272 [-6.090 to - 0.454]). No difference in efficacy was found between L/R versus hydroxychloroquine (HCQ) and L/R versus arbidol. However, in a single randomized controlled trail (open label), chloroquine (CQ) performed better than L/R. The combination L/R with arbidol may be beneficial (in terms of virological clearance and radiological improvement); however, we need more dedicated studies. Single studies report efficacy of L/R + interferon (IFN, either alpha or 1-beta) combination. We need more studies to delineate the proper effect size. Regarding adverse effects, except occurrence of diarrhea (higher in the L/R group), safety was comparable to SOC. CONCLUSION: In our study, no difference was seen between the L/R combination and the SOC arm in terms of "progression to more severe state," "mortality," and virological cure on days 7-10;" however, some benefits in terms of "duration of hospital stay" and "time to virological cure" were seen. No significant difference in efficacy was seen when L/R was compared to arbidol and HCQ monotherapy. Except for the occurrence of diarrhea, which was higher in the L/R group, safety profile of L/R is comparable to SOC. Compared to L/R combination, CQ, L/R + arbidol, L/R + IFN-α, and L/R + IFN-1ß showed better efficacy, but the external validity of these findings is limited by limited number of studies (1 study each).

Out of the closet.

An editorial on lesbian, gay, bisexual, and transgender (LGBT) community and the initiatives of an activist for the community with those of the Society for Mental Health in LAMIC (SoMHiL) as well as the Open Journal of Psychiatry & Allied Sciences (OJPAS®).

The cacophony of emotions in a mental health professional from the isolation ward during coronavirus disease 2019 (COVID-19) pandemic.

This is a narrative of the thoughts of a first-line healthcare worker, and the psychological overview of the same while working in isolation ward and being in quarantine during coronavirus disease 2019 (COVID-19) pandemic.

Tele-mental health during the coronavirus disease 2019 (COVID-19) pandemic.

This editorial highlights the origin of telemedicine in India, and discusses the present and explores the possibilities in the future in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic.

DEGREE AND FACTORS OF BURNOUT AMONG EMERGENCY HEALTHCARE WORKERS IN INDIA.

OBJECTIVE: 'Burnout' among emergency healthcare workers needs focus as they make crucial life changing decisions every day and thus, their state of physical and mental wellbeing is an absolute necessity. We aimed to find the level and factors contributing to burnout among the healthcare workers in the busiest Emergency Department of Northeast India. This is the first study done in this department to assess burnout. METHOD: This cross-sectional, questionnaire-based study assessed burnout of the doctors, nurses, and paramedics working in an emergency department of a busy tertiary care teaching institute. Association of demographic variables and factors influencing burnout was explored. Results were analyzed by descriptive and inferential statistics. RESULTS: Low level in emotional exhaustion, moderate level in depersonalization, and moderate level in the lack of personal accomplishment was reported by participants. Children and partner were found to be protective factors. Working hours, duration and status (permanent/contractual) of service influenced burnout. CONCLUSION: Knowing the level of burnout and their determinants can help in formulating measures of improving the work environment. A healthy workforce ensures high quality of healthcare and patient satisfaction.

Reflections on and discussions about 'Luminous Life: A New Model of Humanistic Psychotherapy'.

This paper is an attempt to introduce a new approach in Humanistic Psychotherapy. It grew out of a psychiatry consultant's years of work in individual psychotherapy with the patients and got published in a self-help format. Later a clinical psychology consultant read the book and reflected in detail on it. Then the colleagues contacted each-other and had some discussions on the reflections. Few patients' feedback was also included. Initially there are two chapters of Introduction and Humanistic Approach to Mental Health Problems. The major modules in the book comprise Health, Forgiveness, Self, Connections, Will-Power, Relationships, and Living with the Family. The additional modules include Time, Negotiation, Creativity, and Celebrating the Common Person. Also there are two final modules, Orientation for a Possible Future Culture and Summing Up. The paper narrates the entire process of reflection and the related discussion and highlights the major points of this new model of therapy.

PATTERN OF SUBSTANCE USE IN A DRUG DEADDICTION CENTRE IN DIPHU- NORTHEAST INDIA-BASED STUDY.

BACKGROUND: India is a multicultural and multilingual democracy; the use of different substances is found to be regionally diversified. Ethnic variations have contributed to this diversification and so a single study on a particular region cannot be generalised to the whole Indian population. Alcohol is one of the most popular substances used in India which can be traced backed to the scriptures. The local homemade liquor is the most common form of liquor used by the Indian population. The traditional winemaking process is common among the different ethnic tribes of Northeast India and thus most of the alcohol use is unrecorded in this part of the country. MATERIALS AND METHODS: An observational study was conducted in the Drug Deaddiction Centre of Diphu Civil Hospital, Assam where patients' recorded data over a four-year period was used. The data was reviewed retrospectively to understand the pattern of substance use in this region and the results were described using descriptive statistics. RESULTS: Alcohol was found to be the most used substance and significant gender difference was noted among the users. Both tribal and nontribal groups were almost equally seen to use alcohol while around one-fifth of the population belonged to the age group of less than 30 years. Early initiation of alcohol use due to cultural reasons was suspected. Various health issues ranging from gastrointestinal (GI) symptoms to death due to alcohol misuse were reported. Due to the retrospective review process, missing data was found to be a significant limitation to this study. CONCLUSION: Adequate health promotion focusing on effects of alcohol on health should be undertaken in this region and proper follow-up of the treated patients should be done to prevent relapse.

A COMPREHENSIVE STUDY REGARDING CONTRIBUTION OF SOCIAL NETWORKING SITES (SNS) TO MENTAL STRESS, ANXIETY, AND DEPRESSION AMONG ADOLESCENT SCHOOL STUDENTS IN GUWAHATI: THE RESEARCH DESIGN.

BACKGROUND: The study was designed to measure the degree of depression, anxiety, and stress amongst adolescent school children with respect to addiction to Social Networking Sites (SNS) as well as to study the various factors that could predispose to SNS addiction, and to study the habits and behaviour that places them at risk to SNS addiction. METHOD: Adolescent school children who fall under the age group of 14-18 years studying in various schools of Guwahati will form the study population. Data would be collected through questionnaire. RESULT: The analysis is planned by both descriptive as well as inferential statistics. CONCLUSION: The impact of SNS to mental health can be ascertained. The underlying factors predisposing to addiction would be found out. Formulation of strategies to counter the problem could be arrived at. Thus, restoring the health and wellbeing of the students.

Father and son attachment styles in alcoholic and non-alcoholic families.

BACKGROUND: The theory of attachment is important to understand a lot of human behaviour. Styles of attachment could be important predictors in developing dependence on alcoholism. Insecure attachment patterns could be significant risk factors for future alcohol use. METHODS: Participants for this study consist of fathers with alcohol dependence syndrome (ADS) from treatment centres and fathers from the community with no dependency on alcohol, and their sons (n=200). The Michigan Alcoholism Screening Test (MAST), socioeconomic status scale were administered, and attachment styles were derived by the Attachment Style Questionnaire (ASQ). We hypothesised a prior concept reflecting theoretical predictions for the association between attachment styles and alcohol in both the generations. RESULTS: Statistics on SPSS-16 was used to test our hypotheses. As predicted, fathers with ADS had insecure attachments styles in comparison to the control group. Substance abuse/dependence and treatment participation were at an all-time low for the secure group. CONCLUSION: The findings from this study identify attachment styles as an influential factor in understanding the divergence between alcohol dependence in treatment seekers. The findings further imply that differential treatment may need to be provided taking into account one's attachment representation to promote successful recovery. It also highlights the need to develop secure ties in children of alcoholic parents to protect them from use of substances as a coping and a learned mechanism. Limitations of the study and suggestions for further research are highlighted and implications for diagnosis and treatment are discussed.

Characterizing Anxiety Among Individuals Receiving Treatment for Alcohol and Substance Use Disorders.

BACKGROUND: Despite high prevalence of generalized anxiety disorder (GAD) substance use disorder (SUD) comorbidity, little is known regarding demographic characteristics associated with GAD in SUD treatment seekers. OBJECTIVE: To characterize demographic differences between inpatient SUD treatment seekers reporting varying levels of GAD symptomatology. DESIGN: General linear models, chi-square test, t test, and correlational analyses were utilized to assess group differences. Groups included those with no history of significant anxiety (No GAD; n = 256), subclinical anxiety (Subclinical; n = 85), and those meeting GAD diagnostic criteria (GAD; n = 61). RESULTS: The No GAD group differed substantially from Subclinical and GAD individuals. With the exception of polysubstance use, no differences were found regarding Subclinical and GAD groups. CONCLUSION: Individuals with subclinical GAD symptoms and those meeting diagnostic criteria were nearly identical regarding precursors to problematic substance use, severity of use, and key mental health indicators. Findings suggest subclinical levels of GAD should not be overlooked when assessing and treating SUDs.

Impact of stress, coping, social support, and resilience of families having children with autism: A North East India-based study.

Children with autism (CWA) is a segment of population in North East India who are marginalized due to lack of resources like skilled manpower and perceived stress. In comparison to other states and countries whether these children are unique in terms of care and rehabilitation from adult caregivers was the focus of our study. The study assessed level of parental stress, social support, coping mechanisms used by family and resilience in meeting the challenges as caregivers. Parents were selected by simple random sampling from a multi-specialty center dedicated to CWA. They were assessed with the help of structured tools like the Parental Stress Scale, the social support appraisals scale, the coping self-efficacy scale, and the Family Resilience Assessment Scale. Results were analyzed with descriptive statistics and findings suggest definite stress among the parents of CWA. Personal time constraint was noticed in majority of parents, which had adversely affected their professional lives. Despite wide array of stress factors, family members had satisfactory coping skills to work in harmony in adverse circumstances. Regarding secondary social support in terms of family, friends, and neighbors, responses were mixed; religious and spirituality were often resorted avenues. Social desirability, fatigue and the sample being restricted to only one center were though the limitations but, this study throws light on pertinent issues related to families with CWA from a region where specialty centers are a rarity. The future implication could focus on CWA's future, rehabilitation, care and parental concerns which are grossly neglected in North East India.

Global psychiatry: a LAMIC perspective.

This editorial highlights the nouveau approach of OJPAS® to promote psychiatry in low and middle income countries (LAMIC), with research contributions from a global consortium.

Parents' attitude towards children and adolescents with intellectual developmental disorder.

The study attempted to explore the attitude of parents towards their mentally retarded children. The sample consisted of 66 parents of children with intellectual developmental disorder (IDD) receiving mental health services from two daycare centers. An attitude questionnaire was administered on the parents who were involved in the care and rehabilitation of the child. The questionnaire comprised of fifty statements of a Likert-type scale and it served as the measuring instrument. Questions were designed to provide information on parents' behavior, perception, reaction, values, and feelings. The important themes that emerged out of the questionnaire were analyzed using descriptive statistics. The results indicated that the parents, though had love and acceptance towards their children, but were frustrated, disappointed, and highly overprotective. This was a significant deterrent factor in the child's adaptive functioning and development of his/her independent living skills.

Social cognitive deficits and need for social cognitive remediation in schizophrenia.

The construct of social cognition provides a perspective on how people process information within social contexts. Social brain evolution is an adaptive response to the increasingly complex social environment. Social cognitive deficits in patients with schizophrenia determine functional outcome. Social cognitive deficits in schizophrenia could serve as targets for novel treatment applications. Culturally validated tools to measure these deficits in the Indian setting have been developed. Social cognitive training has promise in this regard.

'White handkerchief': a patient of attenuated psychosis syndrome.

The case history of a patient with attenuated psychosis syndrome is discussed under the backdrop of controversies. On one hand, there is apprehension regarding diagnostic validity, associated stigma, unnecessary treatment, and ethical dilemmas. On the other hand, there is possibility of primary prevention.